Provider Demographics
NPI:1225790645
Name:DIXON, HEATHER S (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:S
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 INTERSTATE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2704
Mailing Address - Country:US
Mailing Address - Phone:931-250-5577
Mailing Address - Fax:
Practice Address - Street 1:229 INTERSTATE DR STE 103
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2704
Practice Address - Country:US
Practice Address - Phone:931-250-5577
Practice Address - Fax:931-250-5575
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily