Provider Demographics
NPI:1700476942
Name:RHODES, NICKY MAE
Entity Type:Individual
Prefix:
First Name:NICKY
Middle Name:MAE
Last Name:RHODES
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 1:86 MIDDLE FRK
Mailing Address - Street 2:
Mailing Address - City:REEDY
Mailing Address - State:WV
Mailing Address - Zip Code:25270-9308
Mailing Address - Country:US
Mailing Address - Phone:304-377-2281
Mailing Address - Fax:
Practice Address - Street 1:86 MIDDLE FRK
Practice Address - Street 2:
Practice Address - City:REEDY
Practice Address - State:WV
Practice Address - Zip Code:25270-9308
Practice Address - Country:US
Practice Address - Phone:304-377-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant