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NPI Code Detail

MEDICARE: DAVID W NIXON ATC

MEDICARE: DAVID W NIXON ATC
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
12255A2300XAthletic Trainer

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122OTHERRESPIRATORY, REHABILITATIVE, RESTORATIVE SERVICES PROVIDER

General Provider Information

NPI Number : 1285147546
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID W NIXON ATC
Provider Business Mailing Address
First Line : 2615 SHIRLEY AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1358
Country : US
Telephone Number : 469-865-3627
Fax Number :
Provider Business Practice Location Address
First Line : 2615 SHIRLEY AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1358
Country : US
Telephone Number : 469-865-3627
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2017
Last Update Date : 11/09/2017

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Directions to “ DAVID W NIXON ATC” Practice Location

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