Healthcare Provider Details

I. General information

NPI: 1821740689
Provider Name (Legal Business Name): JANUARY NIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BALLYCLARE TER
CINCINNATI OH
45240-4002
US

IV. Provider business mailing address

460 BALLYCLARE TER
CINCINNATI OH
45240-4002
US

V. Phone/Fax

Practice location:
  • Phone: 678-732-6615
  • Fax:
Mailing address:
  • Phone: 678-732-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN427280
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN427280
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN427280
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN427280
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN427280
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN427280
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberRN427280
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberRN427280
License Number StateOH
# 9
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN427280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: