Provider Demographics
NPI:1649750811
Name:DIXON, BRITTANY D (FNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:D
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:D
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37822-0577
Mailing Address - Country:US
Mailing Address - Phone:423-613-3300
Mailing Address - Fax:423-623-4088
Practice Address - Street 1:229 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2902
Practice Address - Country:US
Practice Address - Phone:423-623-1057
Practice Address - Fax:423-625-8620
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ043894Medicaid