Provider Demographics
NPI:1245030352
Name:PRAVECEK, NIKITA NIEBERT (RN)
Entity type:Individual
Prefix:MRS
First Name:NIKITA
Middle Name:NIEBERT
Last Name:PRAVECEK
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13807 JOHN LEE RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8760
Mailing Address - Country:US
Mailing Address - Phone:347-854-5106
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5210 BOX 230
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461-5210
Practice Address - Country:US
Practice Address - Phone:347-854-5106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN253183163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse