MEDICARE: PRESLIE NIXON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1568041580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRESLIE NIXON

Provider Business Mailing Address
First Line	:	141 AMBER LAKE DR
Second Line	:
City	:	BALL GROUND
State	:	GA
Zip	:	30107-7605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 SOUND RD
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-7813
Country	:	US
Telephone Number	:	910-803-2400
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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Directions to “ PRESLIE NIXON ” Practice Location

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