Provider Demographics
NPI:1902204258
Name:CHEN, NIKKI (ARNP-C)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:LASHAY
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 EAST LEE STREET
Mailing Address - Street 2:STE C
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330
Mailing Address - Country:US
Mailing Address - Phone:334-348-8818
Mailing Address - Fax:334-393-8773
Practice Address - Street 1:805 EAST LEE STREET
Practice Address - Street 2:STE C
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330
Practice Address - Country:US
Practice Address - Phone:334-348-8818
Practice Address - Fax:334-393-8773
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126856363L00000X
FL9382341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily