Basic Information
| Provider Information | |||||||||
| NPI: | 1730666025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOVNER | ||||||||
| FirstName: | NIKKI | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 PRESTON CT | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312105772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787452345 | ||||||||
| FaxNumber: | 4787451225 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PRESTON CT | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312105772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787452385 | ||||||||
| FaxNumber: | 4787451225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 05/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F07180276 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.