Healthcare Provider Details

I. General information

NPI: 1164222717
Provider Name (Legal Business Name): PENINNAH DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 KEY WEST MEWS
CARY NC
27513-4186
US

IV. Provider business mailing address

614 KEY WEST MEWS
CARY NC
27513-4186
US

V. Phone/Fax

Practice location:
  • Phone: 256-630-7382
  • Fax:
Mailing address:
  • Phone: 256-630-7382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: