Healthcare Provider Details

I. General information

NPI: 1699713867
Provider Name (Legal Business Name): DAVID DIXON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 E HARRY ST
WICHITA KS
67218-3713
US

IV. Provider business mailing address

PO BOX 47222
WICHITA KS
67201-7222
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5775
  • Fax: 316-291-7496
Mailing address:
  • Phone: 316-268-5775
  • Fax: 316-291-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95141447
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44490
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: