Provider Demographics
NPI:1538853924
Name:HACKNEY, NICKOLE (RRT)
Entity type:Individual
Prefix:
First Name:NICKOLE
Middle Name:
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36996 WALNUT PARK LN
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3499
Mailing Address - Country:US
Mailing Address - Phone:304-616-0645
Mailing Address - Fax:
Practice Address - Street 1:36996 WALNUT PARK LN
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3499
Practice Address - Country:US
Practice Address - Phone:304-616-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT227900000X
MA227900000X
VA227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered