Individual
CAROLYN KYLE NIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD., PORTLAND, OR 97239-3011
(503) 494-7551
Mailing address
3181 SW SAM JACKSON PARK RD., MAIL CODE SJH-2, PORTLAND, OR 97239-3011
(503) 494-7551
(503) 494-4997
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA170105
OR
363AM0700X
Medical Physician Assistant
Primary
PA170105
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500679615
—
OR
Enumeration date
08/06/2009
Last updated
02/01/2021
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