Healthcare Provider Details

I. General information

NPI: 1518978972
Provider Name (Legal Business Name): KERRI ANN DIXON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 E MOUND RD
DECATUR IL
62526-9650
US

IV. Provider business mailing address

3035 EAST MOUND ROAD
DECATUR IL
62526
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-7700
  • Fax: 217-875-2689
Mailing address:
  • Phone: 217-875-7700
  • Fax: 217-875-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001426
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041193018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: