Provider Demographics
NPI:1487214193
Name:NIX, JAVONDA (MPH)
Entity Type:Individual
Prefix:MS
First Name:JAVONDA
Middle Name:
Last Name:NIX
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 BRIGHT DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127
Mailing Address - Country:US
Mailing Address - Phone:504-615-9801
Mailing Address - Fax:
Practice Address - Street 1:3308 TULANE AVE STE 407
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7158
Practice Address - Country:US
Practice Address - Phone:504-821-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator