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General NPI Number Information
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NPI Number | 1619389046
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Entity Type | Individual
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Provider Name | SHAKIMA NIXON FNP
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Gender | Female
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 12016 LEMMOND FARM DR STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28227-8353
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Country | US
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Telephone | 704-863-9615
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19305
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City | CHARLOTTE
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State | NC
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Zip | 28219-9305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5006890
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5006890
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License Number State | NC
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