Provider Demographics
NPI:1790562452
Name:NIXON, KASEY MERIE
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:MERIE
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 1:520 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MINGO JUNCTION
Mailing Address - State:OH
Mailing Address - Zip Code:43938-1139
Mailing Address - Country:US
Mailing Address - Phone:740-457-9474
Mailing Address - Fax:
Practice Address - Street 1:315 WALKER ST
Practice Address - Street 2:
Practice Address - City:TILTONSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43963-1028
Practice Address - Country:US
Practice Address - Phone:740-859-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant