Provider Demographics
NPI:1912268350
Name:DIXON, MADINA C (NP)
Entity Type:Individual
Prefix:
First Name:MADINA
Middle Name:C
Last Name:DIXON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-3488
Mailing Address - Country:US
Mailing Address - Phone:601-936-1395
Mailing Address - Fax:601-933-6596
Practice Address - Street 1:111 COLONY CROSSING WAY STE 250
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6832
Practice Address - Country:US
Practice Address - Phone:601-326-6401
Practice Address - Fax:601-326-6405
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS859416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00836029Medicaid
MS343589YJ9XMedicare PIN