Provider Demographics
NPI:1942380977
Name:SALMON, NICKEEY KISSIAN (MD)
Entity type:Individual
Prefix:
First Name:NICKEEY
Middle Name:KISSIAN
Last Name:SALMON
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 1:8245 COUNTY ROAD 44 LEG A STE 2
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3751
Mailing Address - Country:US
Mailing Address - Phone:352-326-3366
Mailing Address - Fax:
Practice Address - Street 1:8245 COUNTY ROAD 44 LEG A STE 2
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3751
Practice Address - Country:US
Practice Address - Phone:407-955-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN7776208000000X
FLME99391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000568000Medicaid