Provider Demographics
NPI:1619060431
Name:NIXON, JAMIE LANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LANE
Last Name:NIXON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BLACK HILLS LN SW STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8600
Mailing Address - Country:US
Mailing Address - Phone:360-709-9500
Mailing Address - Fax:360-754-4517
Practice Address - Street 1:403 BLACK HILLS LN SW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8600
Practice Address - Country:US
Practice Address - Phone:360-709-9500
Practice Address - Fax:360-754-4517
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005075363A00000X
WAOA10000245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00346592OtherRAILROAD MEDICARE
WA8464158Medicaid
WA8464158Medicaid
ML1479408OtherDEA
Q73375Medicare UPIN
8860726Medicare PIN