Provider Demographics
NPI:1255593364
Name:DIXON, TAMMY LOFTON (FNP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LOFTON
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:174 SPRINGFIELD TRL SW
Mailing Address - Street 2:
Mailing Address - City:BOGUE CHITTO
Mailing Address - State:MS
Mailing Address - Zip Code:39629-8209
Mailing Address - Country:US
Mailing Address - Phone:601-757-1296
Mailing Address - Fax:
Practice Address - Street 1:427 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2350
Practice Address - Country:US
Practice Address - Phone:601-835-9165
Practice Address - Fax:601-835-9164
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858704363LF0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR858704OtherMS LICENSE