Provider Demographics
NPI:1356785984
Name:NIXON, JOHN ACHILLES (CPC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ACHILLES
Last Name:NIXON
Suffix:
Gender:M
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 S FORT APACHE RD
Mailing Address - Street 2:#108-104
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6416
Mailing Address - Country:US
Mailing Address - Phone:602-684-7564
Mailing Address - Fax:
Practice Address - Street 1:9679 DELIVERY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5514
Practice Address - Country:US
Practice Address - Phone:702-522-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIP130215001101YM0800X
AZLPC-1241101YP2500X
NVCP0075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional