Provider Demographics
NPI:1205947215
Name:STEWART-DIXON, TAMMY TERESA (FNPC)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:TERESA
Last Name:STEWART-DIXON
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 EVANGELINE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-820-4065
Mailing Address - Fax:318-325-0316
Practice Address - Street 1:2803 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3749
Practice Address - Country:US
Practice Address - Phone:318-325-0325
Practice Address - Fax:318-326-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141283Medicaid
LA4H087Medicare ID - Type Unspecified
LA1141283Medicaid