Provider Demographics
NPI:1760710677
Name:NIX, WENDY W (FNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:W
Last Name:NIX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22725 HIGHWAY 76 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7527
Mailing Address - Country:US
Mailing Address - Phone:864-833-9111
Mailing Address - Fax:864-833-9493
Practice Address - Street 1:210 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2505
Practice Address - Country:US
Practice Address - Phone:864-833-0973
Practice Address - Fax:864-241-9290
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1549Medicaid
SCAA4873AMedicare PIN