Individual provider Active NPI

Nikeisha Clevia Oliver

  • Family Nurse Practitioner
  • Stone Mountain, GA
National Provider Identifier
1043080641
Registry record updated Oct 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN-NP228269 Issued in GA
Practice address
1227 Rockbridge Rd
Stone Mountain, GA 30087-3064
Phone
(770) 413-1476
NPI assigned
Jan 4, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN-NP228269 GA Primary

Addresses

Primary practice location

1227 Rockbridge Rd
Stone Mountain, GA 30087-3064

Mailing address

PO Box 932958
Cleveland, OH 44193-0028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250311001726 GA Practitioner - Nurse Practitioner 0547781254

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN-NP228269GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
TLC of Georgia LLC Family CurrentSince Nov 4, 2024 Accepting new patients

Locations

505 Dacula Rd
Dacula, GA 30019
Phone (678) 407-8740

455 Nathan Dean Blvd
Dallas, GA 30132
Phone (770) 443-8776

1227 Rockbridge Rd
Stone Mountain, GA 30087
Phone (770) 225-1888

2620 Elm Hill Pike
Nashville, TN 37214
Phone (615) 425-4211

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760054400000",
    "number": "1043080641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932958",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 ROCKBRIDGE RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873064",
            "telephone_number": "770-413-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "NIKEISHA",
        "middle_name": "CLEVIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-04",
        "last_updated": "2025-10-10",
        "certification_date": "2025-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "APRN-NP228269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

Verify at the official NPI Registry.