Provider Demographics
NPI:1497254320
Name:PITTMAN-DIXON, JENNIFER R (PMHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:PITTMAN-DIXON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22480-0671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6810 TEAGLE LANE
Practice Address - Street 2:PO BOX 2133
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061
Practice Address - Country:US
Practice Address - Phone:804-210-1104
Practice Address - Fax:804-210-1105
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175866363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health