Provider Demographics
NPI:1457380750
Name:FOXX, NICKI J (CRNA)
Entity Type:Individual
Prefix:
First Name:NICKI
Middle Name:J
Last Name:FOXX
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:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-0325
Mailing Address - Country:US
Mailing Address - Phone:580-746-2317
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 240
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764-9735
Practice Address - Country:US
Practice Address - Phone:580-746-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR71050367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S06851Medicare UPIN
AR5Y178Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER