Provider Demographics
NPI:1083936710
Name:NIXON, TRACI JINEAN (FNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:JINEAN
Last Name:NIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-4376
Mailing Address - Country:US
Mailing Address - Phone:980-432-1090
Mailing Address - Fax:704-471-3016
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4376
Practice Address - Country:US
Practice Address - Phone:980-432-1090
Practice Address - Fax:704-471-3016
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083936710Medicaid
NCNCI764DMedicare PIN
NC1083936710Medicaid