Provider Demographics
NPI:1790479160
Name:NIXON, NICOLE ANN (PLMHP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:NIXON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:SHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7512 S 177TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-2073
Mailing Address - Country:US
Mailing Address - Phone:402-594-8704
Mailing Address - Fax:
Practice Address - Street 1:11414 W CENTER RD STE 247
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4420
Practice Address - Country:US
Practice Address - Phone:402-594-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health