Provider Demographics
NPI:1588412258
Name:SHAW, NYKICHIA SHAMON (WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:NYKICHIA
Middle Name:SHAMON
Last Name:SHAW
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PRAIRIE VW
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2019
Mailing Address - Country:US
Mailing Address - Phone:910-978-4444
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1829
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28302-1829
Practice Address - Country:US
Practice Address - Phone:910-433-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019848363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health