Provider Demographics
NPI:1205532801
Name:JEAN, NIXON
Entity type:Individual
Prefix:
First Name:NIXON
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 W 17TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2611
Mailing Address - Country:US
Mailing Address - Phone:718-265-0900
Mailing Address - Fax:
Practice Address - Street 1:2873 W 17TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2611
Practice Address - Country:US
Practice Address - Phone:718-265-0900
Practice Address - Fax:718-265-6319
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404753163WP0808X, 363LP0808X
NY649309163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health