Provider Demographics
NPI:1720260276
Name:NIXON, SHANNON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 GOVERNORS DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5126
Mailing Address - Country:US
Mailing Address - Phone:256-533-0833
Mailing Address - Fax:256-533-0855
Practice Address - Street 1:502 GOVERNORS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5126
Practice Address - Country:US
Practice Address - Phone:256-533-0833
Practice Address - Fax:256-533-0855
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083445363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051500675OtherBCBS
AL891001760Medicare PIN