MEDICARE: JAMIE HIXON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	808593	TX

General Provider Information

NPI Number	:	1689955908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE HIXON FNP-BC

Provider Business Mailing Address
First Line	:	520 SAMUELS AVE
Second Line	:	2304
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2399
Country	:	US
Telephone Number	:	512-627-6379
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 SAMUELS AVE
Second Line	:	2304
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2399
Country	:	US
Telephone Number	:	512-627-6379
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	02/17/2012

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