Healthcare Provider Details

I. General information

NPI: 1275339699
Provider Name (Legal Business Name): CECILIA DIXON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MAGEE LN
GROVETON TX
75845-4185
US

IV. Provider business mailing address

111 DEER POND RD
LUFKIN TX
75904-0681
US

V. Phone/Fax

Practice location:
  • Phone: 936-642-0841
  • Fax:
Mailing address:
  • Phone: 936-635-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01250464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: