Provider Demographics
NPI:1013202282
Name:RAY., SHALEESE NIXON
Entity Type:Individual
Prefix:
First Name:SHALEESE
Middle Name:NIXON
Last Name:RAY.
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHALEESE
Other - Middle Name:MARIE
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:474 W. 200 N. #300
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:435-669-7262
Mailing Address - Fax:
Practice Address - Street 1:474 W. 200 N. #300
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-634-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker