Provider Demographics
NPI:1225170731
Name:NIX, HARVEY CLYDE III (PAC)
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:CLYDE
Last Name:NIX
Suffix:III
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9447
Mailing Address - Country:US
Mailing Address - Phone:828-692-6178
Mailing Address - Fax:
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9447
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-356-3998
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-00702OtherPHYSICIAN ASSISTANT
NC0010-00702OtherPHYSICIAN ASSISTANT