Provider Demographics
NPI:1225049083
Name:NIX, ALICE MEREDITHE (ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MEREDITHE
Last Name:NIX
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1530 SSW LOOP 323
Mailing Address - Street 2:SUITE 123
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2562
Mailing Address - Country:US
Mailing Address - Phone:800-478-7902
Mailing Address - Fax:800-517-3583
Practice Address - Street 1:1530 SSW LOOP 323
Practice Address - Street 2:SUITE 123
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2562
Practice Address - Country:US
Practice Address - Phone:800-478-7902
Practice Address - Fax:800-517-3583
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232011363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care