Provider Demographics
NPI:1619614443
Name:DIXON, MONIQUE RENEE (CNM)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RENEE
Last Name:DIXON
Suffix:
Gender:F
Credentials:CNM
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 672
Mailing Address - Street 2:
Mailing Address - City:GLENMORA
Mailing Address - State:LA
Mailing Address - Zip Code:71433-0672
Mailing Address - Country:US
Mailing Address - Phone:318-914-0850
Mailing Address - Fax:
Practice Address - Street 1:7900 HENNEMAN WAY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2914
Practice Address - Country:US
Practice Address - Phone:214-544-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA225313367A00000X
TX1086198367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife