Provider Demographics
NPI:1477097806
Name:SAMPSON, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CORVETTE DR
Mailing Address - Street 2:
Mailing Address - City:KINSEY
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7759
Mailing Address - Country:US
Mailing Address - Phone:334-828-3359
Mailing Address - Fax:
Practice Address - Street 1:65 CORVETTE DR
Practice Address - Street 2:
Practice Address - City:KINSEY
Practice Address - State:AL
Practice Address - Zip Code:36303-7759
Practice Address - Country:US
Practice Address - Phone:334-828-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL589652103374U00000X
AL376J00000X, 376K00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion