Basic Information
| Provider Information | |||||||||
| NPI: | 1194267708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIX | ||||||||
| FirstName: | RACHEL | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 CITY ROUTE 66 | ||||||||
| Address2: | |||||||||
| City: | ST ROBERT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655843730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733365100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 608 CITY ROUTE 66 | ||||||||
| Address2: | |||||||||
| City: | ST ROBERT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 655843730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733365100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2016 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2022029955 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 56030 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.