Provider Demographics
NPI:1689955908
Name:HIXON, JAMIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HIXON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SAMUELS AVE
Mailing Address - Street 2:2304
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-2399
Mailing Address - Country:US
Mailing Address - Phone:512-627-6379
Mailing Address - Fax:
Practice Address - Street 1:520 SAMUELS AVE
Practice Address - Street 2:2304
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2399
Practice Address - Country:US
Practice Address - Phone:512-627-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily