Provider Demographics
NPI:1164806725
Name:DIXON, LYNDSAY
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SUTTON PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8785
Mailing Address - Country:US
Mailing Address - Phone:812-890-9513
Mailing Address - Fax:
Practice Address - Street 1:148 SUTTON PLACE BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8785
Practice Address - Country:US
Practice Address - Phone:812-890-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered