Provider Demographics
NPI:1639685670
Name:NIXON, JAMIE NICOLE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E NAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6837
Mailing Address - Country:US
Mailing Address - Phone:619-395-5561
Mailing Address - Fax:
Practice Address - Street 1:633 E NAPLES ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6837
Practice Address - Country:US
Practice Address - Phone:619-395-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician