Healthcare Provider Details

I. General information

NPI: 1124778501
Provider Name (Legal Business Name): DIXI SKYLAR SECULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 PARK ST
BOWLING GREEN KY
42101-1765
US

IV. Provider business mailing address

523 PARK ST
BOWLING GREEN KY
42101-1765
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-0075
  • Fax: 270-796-2250
Mailing address:
  • Phone: 270-781-0075
  • Fax: 270-796-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberTP252
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: