Provider Demographics
NPI:1851336168
Name:WOOTEN, NIKIA (DO)
Entity Type:Individual
Prefix:DR
First Name:NIKIA
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 BRONX PARK E
Mailing Address - Street 2:#1D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7526
Mailing Address - Country:US
Mailing Address - Phone:646-342-5316
Mailing Address - Fax:
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-9000
Practice Address - Fax:410-601-9468
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH64269207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine