Provider Demographics
NPI:1396224754
Name:DIXON, MALLORY MCGOFF (DNP FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:MCGOFF
Last Name:DIXON
Suffix:
Gender:F
Credentials:DNP FNP-C
Other - Prefix:
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Mailing Address - Street 1:764 WALNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3113
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:6401 POPLAR AVE STE 600
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4808
Practice Address - Country:US
Practice Address - Phone:901-899-5003
Practice Address - Fax:901-899-5004
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ041326Medicaid