Provider Demographics
NPI:1265941660
Name:WILBORN, NIKKI MARIE (NNP)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:MARIE
Last Name:WILBORN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 NORTHSIDE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-5227
Mailing Address - Country:US
Mailing Address - Phone:361-571-3773
Mailing Address - Fax:
Practice Address - Street 1:276 NORTHSIDE RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-5227
Practice Address - Country:US
Practice Address - Phone:361-571-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136321363LN0000X
TX769486163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care