Provider Demographics
NPI:1114941515
Name:DIXON, GLORIA S (NP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:S
Last Name:DIXON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 QUAKER LANE
Mailing Address - Street 2:STE 100-C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262
Mailing Address - Country:US
Mailing Address - Phone:336-878-6027
Mailing Address - Fax:336-878-6189
Practice Address - Street 1:601 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4331
Practice Address - Country:US
Practice Address - Phone:336-878-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC040980163W00000X
NC200097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27000950Medicaid
NC040980OtherRN
2597577AMedicare ID - Type Unspecified
NC27000950Medicaid