Provider Demographics
NPI:1174366371
Name:DIXON, BRIAN KARL
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KARL
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 FRANKLIN FARMS DR RM 130
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5100
Mailing Address - Country:US
Mailing Address - Phone:804-594-3130
Mailing Address - Fax:804-323-5120
Practice Address - Street 1:8700 STONY POINT PKWY STE 120
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1965
Practice Address - Country:US
Practice Address - Phone:804-323-5011
Practice Address - Fax:804-323-5120
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001234606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily