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NPI Code Detail

MEDICARE: MICAH RICHARDS NIXON APRN

MEDICARE: MICAH RICHARDS NIXON APRN
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
1363LF0000XFamily Nurse Practitioner12687842-4405UT
2163W00000XRegistered Nurse12687842-3102UT

General Provider Information

NPI Number : 1326889452
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICAH RICHARDS NIXON APRN
Provider Business Mailing Address
First Line : 15187 S WILD HORSE WAY
Second Line :
City : BLUFFDALE
State : UT
Zip : 84065-1826
Country : US
Telephone Number : 801-368-2944
Fax Number :
Provider Business Practice Location Address
First Line : 10 S 2000 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84112-5880
Country : US
Telephone Number : 801-581-3413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2024
Last Update Date : 06/02/2026

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