Provider Demographics
NPI:1841568862
Name:SMOKE, NIKKITTA ROSE ANGELIKA (CHA III)
Entity type:Individual
Prefix:
First Name:NIKKITTA
Middle Name:ROSE ANGELIKA
Last Name:SMOKE
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 1ST AVE,
Mailing Address - Street 2:STE 300 COMMUNITY HEALTH AIDE PROGRAM
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3978
Practice Address - Street 1:201 1ST AVE,
Practice Address - Street 2:STE 300 COMMUNITY HEALTH AIDE
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3978
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker