Provider Demographics
NPI:1952979593
Name:DIXON, DELARENTA MORMAN
Entity Type:Individual
Prefix:MRS
First Name:DELARENTA
Middle Name:MORMAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 FM 1488 RD # 10140
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3951
Mailing Address - Country:US
Mailing Address - Phone:281-298-8705
Mailing Address - Fax:
Practice Address - Street 1:3705 FM 1488 RD # 10140
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-3951
Practice Address - Country:US
Practice Address - Phone:281-298-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX815139163WE0003X
TX1150184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency