Provider Demographics
NPI:1972781474
Name:NIX, JILL SUZANNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:SUZANNE
Last Name:NIX
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:4912 US HIGHWAY 42
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6349
Mailing Address - Country:US
Mailing Address - Phone:502-426-9565
Mailing Address - Fax:502-425-3240
Practice Address - Street 1:4912 US HIGHWAY 42
Practice Address - Street 2:SUITE 208
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6349
Practice Address - Country:US
Practice Address - Phone:502-426-9565
Practice Address - Fax:502-425-3240
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY5475P363LF0000X
KY3005475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily