Basic Information
| Provider Information | |||||||||
| NPI: | 1003298274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIX | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 336 GEORGIA AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298413849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032023351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 447 N BELAIR RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | EVANS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308093091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068542222 | ||||||||
| FaxNumber: | 7068542226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2015 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5007711 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 20563 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 236796 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 5007711 | 01 | NC | NURSE PRACTITIONER LICENSE | OTHER | 236796 | 01 | GA | GEORGIA APRN | OTHER | 20563 | 01 | SC | APRN SC | OTHER |