Provider Demographics
NPI:1619582160
Name:HIXSON, JERRY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:HIXSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 BELLUS RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9531
Mailing Address - Country:US
Mailing Address - Phone:330-636-6698
Mailing Address - Fax:
Practice Address - Street 1:1916 BELLUS RD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9531
Practice Address - Country:US
Practice Address - Phone:330-636-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker