Provider Demographics
NPI:1962773143
Name:NIX, KIMBERLY D (CRNA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:NIX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-2344
Mailing Address - Country:US
Mailing Address - Phone:940-889-5572
Mailing Address - Fax:940-889-3337
Practice Address - Street 1:200 STADIUM DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2344
Practice Address - Country:US
Practice Address - Phone:940-889-5572
Practice Address - Fax:940-889-3337
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502061367500000X
TXAP121362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309174603Medicaid