Provider Demographics
NPI:1811600281
Name:DIXON, ROSHANDA J (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:ROSHANDA
Middle Name:J
Last Name:DIXON
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10219 RIVERSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5228
Mailing Address - Country:US
Mailing Address - Phone:502-807-5107
Mailing Address - Fax:
Practice Address - Street 1:10219 RIVERSTONE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5228
Practice Address - Country:US
Practice Address - Phone:800-484-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018776363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health