Provider Demographics
NPI:1679840284
Name:DEEDS, NIKI (PA-C)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:DEEDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-1219
Mailing Address - Country:US
Mailing Address - Phone:402-598-2335
Mailing Address - Fax:
Practice Address - Street 1:3307 BARADA ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2470
Practice Address - Country:US
Practice Address - Phone:402-245-6582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1617363AM0700X
APPLYING363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical