Provider Demographics
NPI:1245338359
Name:DIXON, MARY BETH (PA)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4901 E NC HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9719
Mailing Address - Country:US
Mailing Address - Phone:336-656-9905
Mailing Address - Fax:336-656-5227
Practice Address - Street 1:4901 E NC HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9719
Practice Address - Country:US
Practice Address - Phone:336-656-9905
Practice Address - Fax:336-656-5227
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245338359OtherNC BLUE CROSS
NC2759132BOtherMEDICARE