Provider Demographics
NPI:1093957417
Name:DIXON, RHONDA S (CNM)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:DIXON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2302 BAYOU DR
Mailing Address - Street 2:OWHCI ADMIN
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1781
Mailing Address - Country:US
Mailing Address - Phone:409-203-3525
Mailing Address - Fax:409-217-4532
Practice Address - Street 1:7980 ANCHOR DR STE 1100
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8268
Practice Address - Country:US
Practice Address - Phone:409-203-3525
Practice Address - Fax:409-217-4532
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583844163W00000X
TXAP107938367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467077487Medicaid