Healthcare Provider Details

I. General information

NPI: 1033308861
Provider Name (Legal Business Name): CINDY LEE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY L. DIXON PA-C

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-4400
  • Fax: 573-884-5994
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number16103
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2011021972
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2011021972
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: