Basic Information
Provider Information
NPI: 1003298274
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NIX
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 336 GEORGIA AVE
Address2:  
City: NORTH AUGUSTA
State: SC
PostalCode: 298413849
CountryCode: US
TelephoneNumber: 8032023351
FaxNumber:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X5007711NCN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000X236796GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X20563SCN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
500771101NCNURSE PRACTITIONER LICENSEOTHER
2056301SCAPRN SCOTHER
23679601GAGEORGIA APRNOTHER


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