Provider Demographics
NPI:1942210398
Name:WALDEN, NIKKI ANDERSON (MD)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:ANDERSON
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118383
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-8383
Mailing Address - Country:US
Mailing Address - Phone:972-820-9333
Mailing Address - Fax:972-492-8600
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:SUITE 300
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:972-820-9333
Practice Address - Fax:972-492-8600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8999174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066MHOtherBLUE CROSS BLUE SHIELD
TX4732959OtherCIGNA
TX173131701Medicaid
TX16244OtherPARKLAND
TX4501037598OtherCLIA
TX10016066OtherAMERIGROUP
TX0066MHOtherBLUE CROSS BLUE SHIELD
TX10016066OtherAMERIGROUP