Provider Demographics
NPI:1407499767
Name:DIXSON, JESSICA MARIA (MPH, RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:DIXSON
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-691 KEAAHALA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3569
Mailing Address - Country:US
Mailing Address - Phone:808-233-5473
Mailing Address - Fax:808-233-5482
Practice Address - Street 1:45-691 KEAAHALA RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3569
Practice Address - Country:US
Practice Address - Phone:808-233-5473
Practice Address - Fax:808-233-5482
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered