Provider Demographics
NPI:1265443006
Name:STONE, DIXIE DAVIDSON (PA-C)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:DAVIDSON
Last Name:STONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:SUITE G3
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7490
Mailing Address - Country:US
Mailing Address - Phone:859-235-3638
Mailing Address - Fax:859-235-3536
Practice Address - Street 1:439 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1827
Practice Address - Country:US
Practice Address - Phone:859-234-4494
Practice Address - Fax:859-234-4498
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100086160Medicaid
KYPA910OtherMEDICAL LICENSE
K066831Medicare PIN