Healthcare Provider Details

I. General information

NPI: 1972454734
Provider Name (Legal Business Name): ELIZABETH NIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 TULARE ST
FRESNO CA
93721-2287
US

IV. Provider business mailing address

805 E BUCKINGHAM WAY
FRESNO CA
93704-4205
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-3948
  • Fax:
Mailing address:
  • Phone: 559-455-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: