Provider Demographics
NPI:1922308188
Name:NIX, ROY L (PA-C)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:L
Last Name:NIX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE STE 390E
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4817
Mailing Address - Country:US
Mailing Address - Phone:509-777-8778
Mailing Address - Fax:509-777-7890
Practice Address - Street 1:104 W 5TH AVE STE 390E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4817
Practice Address - Country:US
Practice Address - Phone:509-777-8778
Practice Address - Fax:509-777-7890
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60188690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant