Provider Demographics
NPI:1205888112
Name:THOMPSON NIX, RACHELLE T (CRNA)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:T
Last Name:THOMPSON NIX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 3RD CT E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5008
Mailing Address - Country:US
Mailing Address - Phone:205-908-3179
Mailing Address - Fax:
Practice Address - Street 1:5329 3RD CT E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-5008
Practice Address - Country:US
Practice Address - Phone:205-908-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181557367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered