Provider Demographics
NPI:1053664458
Name:NIXON, TARA (SLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 WAKE FOREST RD STE 404
Mailing Address - Street 2:DUKE MEDICINE PLAZA
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7376
Mailing Address - Country:US
Mailing Address - Phone:919-862-5730
Mailing Address - Fax:919-862-5733
Practice Address - Street 1:5213 S ALSTON AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4430
Practice Address - Country:US
Practice Address - Phone:919-620-1055
Practice Address - Fax:919-620-4921
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1307013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist