Provider Demographics
NPI:1417738311
Name:DIXON, BLAKE ANDREW (APRN)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:ANDREW
Last Name:DIXON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 SW GUNSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-4020
Mailing Address - Country:US
Mailing Address - Phone:662-397-0914
Mailing Address - Fax:
Practice Address - Street 1:2301 W PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-7033
Practice Address - Country:US
Practice Address - Phone:479-326-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily