Provider Demographics
NPI:1992230049
Name:BAUER, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:607 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68638-3112
Mailing Address - Country:US
Mailing Address - Phone:308-550-1595
Mailing Address - Fax:
Practice Address - Street 1:309 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3219
Practice Address - Country:US
Practice Address - Phone:308-550-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health