Healthcare Provider Details

I. General information

NPI: 1386845196
Provider Name (Legal Business Name): JANETTE LASHAY DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 RICHARDS RD
NORTH LITTLE ROCK AR
72117-2653
US

IV. Provider business mailing address

8004 CHARLES LN UNIT A
NORTH LITTLE ROCK AR
72117-1584
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-2220
  • Fax:
Mailing address:
  • Phone: 501-213-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: