Provider Demographics
NPI:1114085834
Name:DIXON, JENNEFER DORIS (NP-C, FNP, MSN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JENNEFER
Middle Name:DORIS
Last Name:DIXON
Suffix:
Gender:F
Credentials:NP-C, FNP, MSN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HOSPITAL DR.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030
Mailing Address - Country:US
Mailing Address - Phone:615-735-0700
Mailing Address - Fax:
Practice Address - Street 1:133 HOSPITAL DR.
Practice Address - Street 2:SUITE 500
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030
Practice Address - Country:US
Practice Address - Phone:615-735-0700
Practice Address - Fax:615-735-5480
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12396363LF0000X
TN141259163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN12396OtherSTATE LICENSE