Individual
TIMOTHY WIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 MECHANIC ST, LEXINGTON, KY 40507-1086
(859) 272-7483
Mailing address
107 SHUN PIKE, NICHOLASVILLE, KY 40356-1452
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
11/08/2016
Last updated
11/09/2016
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