Healthcare Provider Details

I. General information

NPI: 1780075473
Provider Name (Legal Business Name): SAMUEL ALLEN NIX FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 E 9TH ST STE 15
TEXARKANA AR
71854-5818
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 870-621-0080
  • Fax: 870-621-0081
Mailing address:
  • Phone: 870-856-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004574
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: