Provider Demographics
NPI:1679716856
Name:KEEFER, NIKKI LYN (PHD, BCBA)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:LYN
Last Name:KEEFER
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 ALRIX DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3160
Mailing Address - Country:US
Mailing Address - Phone:407-489-2121
Mailing Address - Fax:407-352-2026
Practice Address - Street 1:4541 ALRIX DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3160
Practice Address - Country:US
Practice Address - Phone:407-489-2121
Practice Address - Fax:407-352-2026
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0516103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685758298OtherMEDWAIVER
FL685758296OtherMEDWAIVER DD