Healthcare Provider Details

I. General information

NPI: 1104137496
Provider Name (Legal Business Name): ROSETTA D. HIXSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

PO BOX 35100
BILLINGS MT
59107-5100
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-2345
  • Fax: 317-583-3099
Mailing address:
  • Phone: 406-238-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMED-PHYS-LIC-65836
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01096040A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.206370
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0451727
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number206370
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: