Provider Demographics
NPI:1992023360
Name:DARNELL, NIKOSI SHANTEA (MS, CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:NIKOSI
Middle Name:SHANTEA
Last Name:DARNELL
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10017 LONG RIFLE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4154
Mailing Address - Country:US
Mailing Address - Phone:817-692-8040
Mailing Address - Fax:
Practice Address - Street 1:10017 LONG RIFLE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4154
Practice Address - Country:US
Practice Address - Phone:817-692-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist