Provider Demographics
NPI:1669839189
Name:DIXON, TRAYCE M (APRN)
Entity Type:Individual
Prefix:
First Name:TRAYCE
Middle Name:M
Last Name:DIXON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRAYCE
Other - Middle Name:M
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9523 US HIGHWAY 42 UNIT 785
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-5031
Mailing Address - Country:US
Mailing Address - Phone:502-593-8877
Mailing Address - Fax:
Practice Address - Street 1:1405 BROWNS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-896-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100396870Medicaid