Provider Demographics
NPI:1730062308
Name:VICKERS, NIKISHA R
Entity type:Individual
Prefix:
First Name:NIKISHA
Middle Name:R
Last Name:VICKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2714
Mailing Address - Country:US
Mailing Address - Phone:917-444-2525
Mailing Address - Fax:
Practice Address - Street 1:1524 BUCKINGHAM ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4307
Practice Address - Country:US
Practice Address - Phone:917-444-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator