Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP2300X | Nurse Practitioner - Primary Care | 2021004672 | MO |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 53-79934-062 | KS |
NPI | 1023600574 |
---|---|
Provider Name | Anna Nixon |
First Address | Lees Summit, MO 64086-5589 |
Second Address | Overland Park, KS 66210-4107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 05/02/2021 |