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NPI Code Detail

MEDICARE: TARA NIXON SLP

MEDICARE: TARA NIXON SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist1307013NC

General Provider Information

NPI Number : 1053664458
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA NIXON SLP
Provider Business Mailing Address
First Line : 3480 WAKE FOREST RD STE 404
Second Line : DUKE MEDICINE PLAZA
City : RALEIGH
State : NC
Zip : 27609-7376
Country : US
Telephone Number : 919-862-5730
Fax Number : 919-862-5733
Provider Business Practice Location Address
First Line : 5213 S ALSTON AVE
Second Line :
City : DURHAM
State : NC
Zip : 27713-4430
Country : US
Telephone Number : 919-620-1055
Fax Number : 919-620-4921
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2012
Last Update Date : 11/01/2012

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