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NPI Code Detail

MEDICARE: TIANNA DENISE DIXON

MEDICARE: TIANNA DENISE DIXON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1417610346
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIANNA DENISE DIXON
Provider Business Mailing Address
First Line : 300 N DENVER AVE
Second Line :
City : TULSA
State : OK
Zip : 74103-1420
Country : US
Telephone Number : 405-740-6192
Fax Number :
Provider Business Practice Location Address
First Line : 300 N DENVER AVE
Second Line :
City : TULSA
State : OK
Zip : 74103-1420
Country : US
Telephone Number : 405-740-6192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2021
Last Update Date : 06/28/2024

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Directions to “ TIANNA DENISE DIXON ” Practice Location

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