Provider Demographics
NPI:1922620962
Name:LONGMORE, RIKKI NICOLE (DO)
Entity type:Individual
Prefix:
First Name:RIKKI
Middle Name:NICOLE
Last Name:LONGMORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 814 BOX 19
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09266-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NSA SOUDA BAY
Practice Address - Street 2:MOUZOURAS AKROTIRIOUS
Practice Address - City:CHANIA
Practice Address - State:CRETE
Practice Address - Zip Code:73100
Practice Address - Country:GR
Practice Address - Phone:314-266-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206731208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice