Provider Demographics
NPI:1093209728
Name:DIXON, KIMBERLY R (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:DIXON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22D MEDICAL GROUP
Mailing Address - Street 2:57950 LEAVENWORTH ST
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221
Mailing Address - Country:US
Mailing Address - Phone:316-759-6300
Mailing Address - Fax:
Practice Address - Street 1:22D MEDICAL GROUP
Practice Address - Street 2:57950 LEAVENWORTH ST
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221
Practice Address - Country:US
Practice Address - Phone:316-640-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant