Individual
STACY NIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1615 JOHNSON ST STE C, JENNINGS, LA 70546-3650
(337) 616-0225
Mailing address
1615 JOHNSON ST STE C, JENNINGS, LA 70546-3650
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20150338
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20150338
—
LA
Enumeration date
01/28/2019
Last updated
01/28/2019
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