Provider Demographics
NPI:1508151309
Name:NIX, ANASTACIA J (MD)
Entity Type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:J
Last Name:NIX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1616 S KENTUCKY ST STE B100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2224
Mailing Address - Country:US
Mailing Address - Phone:806-355-8900
Mailing Address - Fax:806-355-2453
Practice Address - Street 1:2329 ROSS OSAGE ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103
Practice Address - Country:US
Practice Address - Phone:806-350-5790
Practice Address - Fax:806-350-5791
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10038568207Q00000X
TXP6229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine