Provider Demographics
NPI:1942751177
Name:DIXON, JEFFREY (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-3533
Mailing Address - Country:US
Mailing Address - Phone:334-685-1390
Mailing Address - Fax:
Practice Address - Street 1:633 S UNION AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-1836
Practice Address - Country:US
Practice Address - Phone:334-774-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-132112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily