Provider Demographics
NPI:1912262833
Name:GADDIE, NAKISHA R
Entity Type:Individual
Prefix:
First Name:NAKISHA
Middle Name:R
Last Name:GADDIE
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:PO BOX 18016
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-0016
Mailing Address - Country:US
Mailing Address - Phone:317-345-4441
Mailing Address - Fax:
Practice Address - Street 1:6832 N LUFKIN CT
Practice Address - Street 2:
Practice Address - City:MC CORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-9478
Practice Address - Country:US
Practice Address - Phone:317-345-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12-012793-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care