Basic Information
| Provider Information | |||||||||
| NPI: | 1093130205 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIX | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | MCDANIEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850489 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366850489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423949 | ||||||||
| FaxNumber: | 2516313361 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 ENNIS ST | ||||||||
| Address2: | |||||||||
| City: | SARALAND | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365712706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2515442000 | ||||||||
| FaxNumber: | 2515442004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2014 | ||||||||
| LastUpdateDate: | 04/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1-125175 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 157308 | 05 | AL | MEDICAID | 511-48068 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |