Provider Demographics
NPI:1083932552
Name:DIXON, STACEY ANN (MD)
Entity Type:Individual
Prefix:
First Name:STACEY ANN
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 LOUISA RD
Mailing Address - Street 2:FAMILY CARE CENTER- KDMC
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-1091
Mailing Address - Country:US
Mailing Address - Phone:606-739-6095
Mailing Address - Fax:
Practice Address - Street 1:4004 LOUISA ROAD
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-0001
Practice Address - Country:US
Practice Address - Phone:606-739-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine