Provider Demographics
NPI:1093130205
Name:NIX, COURTNEY MCDANIEL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MCDANIEL
Last Name:NIX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850489
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0489
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-631-3361
Practice Address - Street 1:119 ENNIS ST
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2706
Practice Address - Country:US
Practice Address - Phone:251-544-2000
Practice Address - Fax:251-544-2004
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-125175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL157308Medicaid
AL511-48068OtherBLUE CROSS BLUE SHIELD
AL511-48068OtherBLUE CROSS BLUE SHIELD