Healthcare Provider Details

I. General information

NPI: 1063648434
Provider Name (Legal Business Name): DIXIE MARIE BENNETT ANDELMAN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIXIE MARIE LEDGER F.N.P

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14254 SPID DR STE 207
CORPUS CHRISTI TX
78418
US

IV. Provider business mailing address

PO BOX 61160
CORPUS CHRISTI TX
78466-1160
US

V. Phone/Fax

Practice location:
  • Phone: 361-589-4068
  • Fax: 361-589-4079
Mailing address:
  • Phone: 361-884-2904
  • Fax: 361-857-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number684604
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number684604
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP117983
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: