MEDICARE: NICKI J FOXX CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	R71050	AR

General Provider Information

NPI Number	:	1457380750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKI J FOXX CRNA

Provider Business Mailing Address
First Line	:	PO BOX 325
Second Line	:
City	:	IDABEL
State	:	OK
Zip	:	74745-0325
Country	:	US
Telephone Number	:	580-746-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 2 BOX 240
Second Line	:
City	:	VALLIANT
State	:	OK
Zip	:	74764-9735
Country	:	US
Telephone Number	:	580-746-2317
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/09/2007

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