Provider Demographics
NPI:1134749773
Name:NIX, MANDY H (RDN)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:H
Last Name:NIX
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-6263
Mailing Address - Country:US
Mailing Address - Phone:828-413-2970
Mailing Address - Fax:
Practice Address - Street 1:3149 RIVER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-6263
Practice Address - Country:US
Practice Address - Phone:828-413-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005173133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered