Provider Demographics
NPI:1952941692
Name:NUNN, NIKISHIA L
Entity Type:Individual
Prefix:MS
First Name:NIKISHIA
Middle Name:L
Last Name:NUNN
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 1:20242 SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23803-1636
Mailing Address - Country:US
Mailing Address - Phone:804-525-0387
Mailing Address - Fax:
Practice Address - Street 1:20242 SHEFFIELD PL
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23803-1636
Practice Address - Country:US
Practice Address - Phone:804-525-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000000000Medicaid