Healthcare Provider Details

I. General information

NPI: 1154896470
Provider Name (Legal Business Name): JORNEL RARNISE DIXON MSN,APRN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2018
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10627 HILLARY CT
BATON ROUGE LA
70810-2842
US

IV. Provider business mailing address

10627 HILLARY CT
BATON ROUGE LA
70810-2842
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-1616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10026
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP10026
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAP10026
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: