Healthcare Provider Details

I. General information

NPI: 1083932552
Provider Name (Legal Business Name): STACEY ANN DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2010
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 LOUISA ROAD
CATLETTSBURG KY
41129-0001
US

IV. Provider business mailing address

4004 LOUISA RD FAMILY CARE CENTER- KDMC
CATLETTSBURG KY
41129-1091
US

V. Phone/Fax

Practice location:
  • Phone: 606-739-6095
  • Fax:
Mailing address:
  • Phone: 606-739-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number45839
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: