Provider Demographics
NPI:1073209243
Name:DIXON, JOCELYN BAYLES
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:BAYLES
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 NC HIGHWAY 33 W
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-8907
Mailing Address - Country:US
Mailing Address - Phone:847-525-7291
Mailing Address - Fax:
Practice Address - Street 1:2313 NC HIGHWAY 33 W
Practice Address - Street 2:
Practice Address - City:GRIMESLAND
Practice Address - State:NC
Practice Address - Zip Code:27837-8907
Practice Address - Country:US
Practice Address - Phone:847-525-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered