Healthcare Provider Details

I. General information

NPI: 1720291107
Provider Name (Legal Business Name): JOANN DIXON RNC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E HOUSTON ST
TYLER TX
75702-8131
US

IV. Provider business mailing address

1400 S WALL AVE
TYLER TX
75701-3229
US

V. Phone/Fax

Practice location:
  • Phone: 903-535-9041
  • Fax: 903-533-0726
Mailing address:
  • Phone: 903-526-7767
  • Fax: 903-533-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number533115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: