Provider Demographics
NPI:1558158204
Name:PALITZ, NIKKI KANOELANI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:KANOELANI
Last Name:PALITZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 SHALLOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-1507
Mailing Address - Country:US
Mailing Address - Phone:808-203-9855
Mailing Address - Fax:808-203-9855
Practice Address - Street 1:2341 SHALLOW CREEK LN
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-1507
Practice Address - Country:US
Practice Address - Phone:808-203-9855
Practice Address - Fax:808-203-9855
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195729363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health