Healthcare Provider Details

I. General information

NPI: 1689060527
Provider Name (Legal Business Name): TYLER NIX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 09/01/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5798
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9456
  • Fax: 504-894-5446
Mailing address:
  • Phone: 504-896-9456
  • Fax: 504-894-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA162892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number327897
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: