Provider Demographics
NPI:1679571939
Name:NIXON, KENNETH H (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:NIXON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1854
Mailing Address - Country:US
Mailing Address - Phone:330-689-3338
Mailing Address - Fax:330-689-0282
Practice Address - Street 1:4495 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1854
Practice Address - Country:US
Practice Address - Phone:330-689-3338
Practice Address - Fax:330-689-0282
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2719213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0829821Medicaid
OH0829821Medicaid