Provider Demographics
NPI:1447665823
Name:NIXON, MINDY LEIGH (CRNA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LEIGH
Last Name:NIXON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:LEIGH
Other - Last Name:KOVARCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4535 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2932
Mailing Address - Country:US
Mailing Address - Phone:832-563-4527
Mailing Address - Fax:
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125797367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered