Provider Demographics
NPI:1225070204
Name:DIXON, JODY LEE K (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JODY LEE
Middle Name:K
Last Name:DIXON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LEE
Other - Last Name:KLEFFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104
Practice Address - Country:US
Practice Address - Phone:717-221-6258
Practice Address - Fax:717-221-6266
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000432133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN000432OtherLICENSE
PA102287927Medicaid