Healthcare Provider Details

I. General information

NPI: 1700762069
Provider Name (Legal Business Name): LASHANTA RENEE DIXON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 OLD TOWN MALL
BALTIMORE MD
21202-4190
US

IV. Provider business mailing address

101 BUTTERFIELD AVE
TANEYTOWN MD
21787-3600
US

V. Phone/Fax

Practice location:
  • Phone: 443-571-7611
  • Fax:
Mailing address:
  • Phone: 667-367-8403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR245585
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: