Healthcare Provider Details

I. General information

NPI: 1942903026
Provider Name (Legal Business Name): KELLY NICOLE NIXON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ROSENBERGER AVE STE B400
EVANSVILLE IN
47712-6510
US

IV. Provider business mailing address

100 S ROSENBERGER AVE STE B400
EVANSVILLE IN
47712-6510
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-1566
  • Fax: 812-485-1539
Mailing address:
  • Phone: 812-485-1566
  • Fax: 812-485-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02008979A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58.033320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: