Provider Demographics
NPI:1801337746
Name:KING, NIKKIEL (MSN FNP)
Entity type:Individual
Prefix:MRS
First Name:NIKKIEL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:NIKKIEL
Other - Middle Name:
Other - Last Name:LEFEBRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NIKKIEL LEFEBRE
Mailing Address - Street 1:515 NE ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7307
Mailing Address - Country:US
Mailing Address - Phone:503-894-0493
Mailing Address - Fax:423-205-3302
Practice Address - Street 1:515 NE ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7307
Practice Address - Country:US
Practice Address - Phone:503-477-2477
Practice Address - Fax:423-205-3302
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201701614NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily