Basic Information
| Provider Information | |||||||||
| NPI: | 1922628239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIX | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | DORNER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4205 MCAULEY BLVD STE 375 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057494247 | ||||||||
| FaxNumber: | 4057494249 | ||||||||
| Practice Location | |||||||||
| Address1: | 4205 MCAULEY BLVD STE 375 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731209309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057494247 | ||||||||
| FaxNumber: | 4057494249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2020 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 207621 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.