Individual
KELLY NIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BS, CCM
Contact information
Practice address
400 N BROADWAY ST, MOORE, OK 73160-4812
(405) 735-4650
(405) 793-2708
Mailing address
400 N BROADWAY ST, MOORE, OK 73160-4812
(405) 735-4650
(405) 793-2708
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
61421
OK
Other
Enumeration date
01/28/2016
Last updated
01/29/2016
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