Healthcare Provider Details

I. General information

NPI: 1508560442
Provider Name (Legal Business Name): JOANNA V NIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2720 SOUTH BLVD APT 409
CHARLOTTE NC
28209-1569
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax:
Mailing address:
  • Phone: 980-333-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number33924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: