Healthcare Provider Details

I. General information

NPI: 1598524209
Provider Name (Legal Business Name): DIXON LYNN CRAFT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 EAGLE WAY STE 200
HOPKINSVILLE KY
42240-8742
US

IV. Provider business mailing address

10755 EAGLE WAY STE 200
HOPKINSVILLE KY
42240-8742
US

V. Phone/Fax

Practice location:
  • Phone: 270-889-0701
  • Fax: 270-889-0556
Mailing address:
  • Phone: 270-889-0701
  • Fax: 270-889-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3444
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: