Provider Demographics
NPI:1790707255
Name:ROCHESTER, DIXIE AUTUM (RN, BSN, NP)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:AUTUM
Last Name:ROCHESTER
Suffix:
Gender:F
Credentials:RN, BSN, NP
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 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:703 S FLEISHEL AVE
Practice Address - Street 2:STE 5000
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2015
Practice Address - Country:US
Practice Address - Phone:903-606-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679723363L00000X
TXAP115010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-5720165OtherTRICARE
TX75-2616977-123OtherTRICARE
TX8748MCOtherBCBS
TX190351005Medicaid
TX8858NHOtherBCBS
TX75-2616977-120OtherTRICARE
TX190351006Medicaid
TX190351005Medicaid
TXP01369530Medicare Oscar/Certification
TX75-2616977-120OtherTRICARE