Provider Demographics
NPI:1437878618
Name:DIXON, KATHY (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PRIVATE ROAD 4252
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-9093
Mailing Address - Country:US
Mailing Address - Phone:740-532-4399
Mailing Address - Fax:
Practice Address - Street 1:22 PRIVATE RD 4252
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659
Practice Address - Country:US
Practice Address - Phone:740-532-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3747P1801XMedicaid