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General NPI Number Information
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NPI Number | 1144843137
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Entity Type | Individual
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Provider Name | AMANDA ELAINE DIXON M.ED., ATC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2020
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 516B N. STREET
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547
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Country | US
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Telephone | 910-451-7478
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Fax |
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Provider Business Mailing Address
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Address Line | 5116 WESTERN BLVD APT 908
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City | JACKSONVILLE
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State | NC
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Zip | 28546-0022
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Country | US
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Telephone | 859-421-2261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-868
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License Number State | AR
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