Provider Demographics
NPI:1639340987
Name:WORRELL, NIKKIA HENDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKKIA
Middle Name:HENDERSON
Last Name:WORRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKKIA
Other - Middle Name:ROCHELLE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:915 TATE BLVD SE
Mailing Address - Street 2:STE 170
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-345-0800
Mailing Address - Fax:828-345-0350
Practice Address - Street 1:915 TATE BLVD SE
Practice Address - Street 2:STE 170
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-345-0800
Practice Address - Fax:828-345-0350
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001356207V00000X
AZ42473207V00000X
NC2012-01608207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921465Medicaid
NCNC8828BMedicare PIN