Provider Demographics
NPI:1386452829
Name:SMITH, NIKKISHA NICOLE (PHD, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:NIKKISHA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NW 187TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2370
Mailing Address - Country:US
Mailing Address - Phone:954-559-3767
Mailing Address - Fax:
Practice Address - Street 1:5200 NW 187TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2370
Practice Address - Country:US
Practice Address - Phone:954-559-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-316403163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty