Individual
DR. NIKKI LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 HOSPITAL PKWY, BEDFORD, TX 76022-6913
(817) 685-4000
Mailing address
PO BOX 960046, OKLAHOMA CITY, OK 73196-0001
(877) 485-4474
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L4538
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158403901
—
TX
05
—
158403906
—
TX
01
—
8F4449
BCBS
TX
01
—
8G7452
BCBS
TX
01
—
P00026012
MEDICARE RAILROAD
TX
01
—
P00052875
RAILROAD MCARE
TX
01
—
P00427826
RAILROAD THRU HEB
TX
Enumeration date
12/22/2005
Last updated
10/20/2010
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