Provider Demographics
NPI:1851673412
Name:DIXON, KARA HARTON (PA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:HARTON
Last Name:DIXON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8904
Mailing Address - Country:US
Mailing Address - Phone:270-305-3409
Mailing Address - Fax:
Practice Address - Street 1:270 BURLEY AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8725
Practice Address - Country:US
Practice Address - Phone:270-887-6767
Practice Address - Fax:270-887-6161
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC047363AM0700X
KYPA1657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100321710Medicaid