Provider Demographics
NPI:1548646847
Name:NIXON, KAYLA (FNP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:D
Other - Last Name:HARNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3290
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-7290
Mailing Address - Country:US
Mailing Address - Phone:541-963-1967
Mailing Address - Fax:541-975-5135
Practice Address - Street 1:710 SUNSET DR STE E
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1200
Practice Address - Country:US
Practice Address - Phone:541-663-3100
Practice Address - Fax:541-975-5135
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201508098NP-PP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500694438Medicaid