Provider Demographics
NPI:1124183454
Name:DIXON, CRISTY (PA-C)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 US HWY 70E
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690
Mailing Address - Country:US
Mailing Address - Phone:828-580-4080
Mailing Address - Fax:828-580-4089
Practice Address - Street 1:2659 US HWY 70E
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690
Practice Address - Country:US
Practice Address - Phone:828-580-4080
Practice Address - Fax:828-580-4089
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103717OtherLICENSE
NCMD1113884OtherDEA