Provider Demographics
NPI:1437757432
Name:DIXON, KATIE JO (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:JO
Other - Last Name:DIXON-BLABOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3701 VINELAND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1206
Mailing Address - Country:US
Mailing Address - Phone:512-552-1112
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290 STE B105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1038
Practice Address - Country:US
Practice Address - Phone:512-790-4376
Practice Address - Fax:517-200-4055
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014598363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care