Provider Demographics
NPI:1225890536
Name:DIXON, JESSIE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:MARIE
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:PO BOX 39488
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1026
Mailing Address - Country:US
Mailing Address - Phone:803-374-0527
Mailing Address - Fax:
Practice Address - Street 1:3205 FREEDOM DR STE 8500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3491
Practice Address - Country:US
Practice Address - Phone:803-374-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily