Provider Demographics
NPI:1427597145
Name:DIXON, KELSI L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELSI
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 ARCOS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3529
Mailing Address - Country:US
Mailing Address - Phone:239-390-3376
Mailing Address - Fax:
Practice Address - Street 1:10200 ARCOS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3529
Practice Address - Country:US
Practice Address - Phone:239-390-3376
Practice Address - Fax:239-333-0474
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241392163W00000X, 363LF0000X
FLAPRN11021058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse