1114485505 NPI number — NIKIA DELORES RITCHIE PMHNP-BC

Table of content: NIKIA DELORES RITCHIE PMHNP-BC (NPI 1114485505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114485505 NPI number — NIKIA DELORES RITCHIE PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RITCHIE
Provider First Name:
NIKIA
Provider Middle Name:
DELORES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114485505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 COMMERCE PLAZA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28372-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-521-2900
Provider Business Mailing Address Fax Number:
910-775-9165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 E DR MARTIN LUTHER KING JR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAXTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28364-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-844-5253
Provider Business Practice Location Address Fax Number:
910-844-3290
Provider Enumeration Date:
03/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  0024177 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1114485505 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1114485505 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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