MEDICARE: BARRY NIXON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	225400000X	OTHER	NV	REHABILITATION PRACTIONER

General Provider Information

NPI Number	:	1104100023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY NIXON

Provider Business Mailing Address
First Line	:	6501 W CHARLESTON BLVD APT 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1096
Country	:	US
Telephone Number	:	725-200-9541
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 S PECOS RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5937
Country	:	US
Telephone Number	:	702-485-2191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	03/17/2018

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