Provider Demographics
NPI:1346720836
Name:NIX, MEGAN LEE (CNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:NIX
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 CLYO RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2767
Mailing Address - Country:US
Mailing Address - Phone:937-425-4000
Mailing Address - Fax:937-425-4002
Practice Address - Street 1:6661 CLYO RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2767
Practice Address - Country:US
Practice Address - Phone:937-425-4000
Practice Address - Fax:937-425-4002
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022993363LP2300X
OHAPRN.CNP.022993363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0318685Medicaid