Provider Demographics
NPI:1831175777
Name:LONG, NIKKI (MD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960046
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:
Practice Address - Street 1:1600 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6913
Practice Address - Country:US
Practice Address - Phone:817-685-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4538207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158403901Medicaid
TX8G7452OtherBCBS
TX158403906Medicaid
TXP00026012OtherMEDICARE RAILROAD
TX8F4449OtherBCBS
TXP00052875OtherRAILROAD MCARE
TXP00427826OtherRAILROAD THRU HEB
TX8G8974Medicare PIN
TXP00052875OtherRAILROAD MCARE
TXP00427826OtherRAILROAD THRU HEB
TXH83218Medicare UPIN