Provider Demographics
NPI:1881158434
Name:MOORE, NIKKI LYNN (APRN)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1444
Mailing Address - Country:US
Mailing Address - Phone:606-314-0053
Mailing Address - Fax:606-212-0226
Practice Address - Street 1:535 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1444
Practice Address - Country:US
Practice Address - Phone:606-314-0053
Practice Address - Fax:606-212-0226
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013092363LF0000X
WV113996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner