Healthcare Provider Details

I. General information

NPI: 1114893625
Provider Name (Legal Business Name): EBONY DIXON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30841 EUCLID AVE STE 201
WILLOUGHBY OH
44094-3100
US

IV. Provider business mailing address

4597 WILBURN DR
SOUTH EUCLID OH
44121-3862
US

V. Phone/Fax

Practice location:
  • Phone: 440-249-7695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043246
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: