Basic Information
| Provider Information | |||||||||
| NPI: | 1538703699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOBILE | ||||||||
| FirstName: | NIKKI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6055 KEATS ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370642795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166606902 | ||||||||
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| Practice Location | |||||||||
| Address1: | 508 AUTUMN SPRINGS CT STE 1A | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370678274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156148833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2019 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PENDING | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | TN | MEDICAID |