Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 48129 | CO |
Y | 207X00000X | Orthopaedic Surgeon | 50066 | KY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 48129 | CO |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 50066 | KY |
NPI | 1326169327 |
---|---|
Provider Name | Star Lynn Nixon |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300002220 | (05) | IN |
7100460960 | (05) | KY |
K220271 | KY MEDICARE (01) | KY |