Healthcare Provider Details

I. General information

NPI: 1861208605
Provider Name (Legal Business Name): KAT NIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHARINE NIXON

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WARHAWK WAY
MONROE LA
71209-0001
US

IV. Provider business mailing address

308 WARHAWK WAY
MONROE LA
71209-0001
US

V. Phone/Fax

Practice location:
  • Phone: 863-617-5632
  • Fax:
Mailing address:
  • Phone: 863-617-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: