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 1:3516 WILD EAGLE RUN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-8131
Mailing Address - Country:US
Mailing Address - Phone:407-489-2121
Mailing Address - Fax:407-951-7075
Practice Address - Street 1:3516 WILD EAGLE RUN
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32766-8131
Practice Address - Country:US
Practice Address - Phone:407-489-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2025-06-11
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