Provider Demographics
NPI:1619966009
Name:THOMPSON, DIXIE ROUTON (ARNP)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:ROUTON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8951
Mailing Address - Country:US
Mailing Address - Phone:850-476-3696
Mailing Address - Fax:850-477-3573
Practice Address - Street 1:4900 GRANDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8951
Practice Address - Country:US
Practice Address - Phone:850-476-3696
Practice Address - Fax:850-477-3573
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1762862363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59088941OtherBCBS AL
FLP00105273OtherMEDICARE RR
FLY017DOtherBCBSFL
FL303385600Medicaid
FL303385600Medicaid
FLE4834YMedicare ID - Type Unspecified