Provider Demographics
NPI:1134287477
Name:PIXLEY-DAWSON, JENNIFER JOANNE (PA -C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOANNE
Last Name:PIXLEY-DAWSON
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOANNE
Other - Last Name:PIXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1260 INNOVATION PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3602
Mailing Address - Country:US
Mailing Address - Phone:317-884-5200
Mailing Address - Fax:317-884-5360
Practice Address - Street 1:1260 INNOVATION PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3602
Practice Address - Country:US
Practice Address - Phone:317-884-5200
Practice Address - Fax:317-884-5360
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001121A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN062110K5Medicare PIN