Provider Demographics
NPI:1699939553
Name:BURLESON, NIKKI LASHELLE (CRNP)
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:LASHELLE
Last Name:BURLESON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:NIKKI
Other - Middle Name:LASHELLE
Other - Last Name:COFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:42320 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-7064
Mailing Address - Country:US
Mailing Address - Phone:205-486-8899
Mailing Address - Fax:205-486-8908
Practice Address - Street 1:42320 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7064
Practice Address - Country:US
Practice Address - Phone:205-486-8899
Practice Address - Fax:205-486-8908
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily