Healthcare Provider Details

I. General information

NPI: 1194267708
Provider Name (Legal Business Name): RACHEL NIX CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 08/18/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 CITY ROUTE 66
ST ROBERT MO
65584-3730
US

IV. Provider business mailing address

608 CITY ROUTE 66
ST ROBERT MO
65584-3730
US

V. Phone/Fax

Practice location:
  • Phone: 573-336-5100
  • Fax:
Mailing address:
  • Phone: 573-336-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022029955
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56030
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: