Healthcare Provider Details

I. General information

NPI: 1346309606
Provider Name (Legal Business Name): NANCY JO NIXON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 S. U.S. 31 UNIVERSITY MEDICAL SPECIALTIES
BERRIEN SPRINGS MI
49103
US

IV. Provider business mailing address

9045 S. U.S. 31 UNIVERSITY MEDICAL SPECIALTIES
BERRIEN SPRINGS MI
49103
US

V. Phone/Fax

Practice location:
  • Phone: 269-473-2222
  • Fax:
Mailing address:
  • Phone: 269-473-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007536
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301007536
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007536
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: