Provider Demographics
NPI:1083134886
Name:AMANDA K NIXON PA-C PC
Entity Type:Organization
Organization Name:AMANDA K NIXON PA-C PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:231-920-1875
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49688-0074
Mailing Address - Country:US
Mailing Address - Phone:231-465-4165
Mailing Address - Fax:231-465-4315
Practice Address - Street 1:202 S HOWARD ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:MI
Practice Address - Zip Code:49688-5123
Practice Address - Country:US
Practice Address - Phone:231-465-4165
Practice Address - Fax:231-465-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty