Basic Information
| Provider Information | |||||||||
| NPI: | 1326502758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIXON | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4513 WILLIAMS DR | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786331302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129303909 | ||||||||
| FaxNumber: | 5128695868 | ||||||||
| Practice Location | |||||||||
| Address1: | 1314 E SONTERRA BLVD STE 2201 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104965792 | ||||||||
| FaxNumber: | 2104967601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2019 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA12606 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.