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General NPI Number Information
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NPI Number | 1649771536
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Entity Type | Individual
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Provider Name | CYNTHIA DIXON GRANT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 306 BRYNN MARR RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7023
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Country | US
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Telephone | 910-353-6406
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Fax |
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Provider Business Mailing Address
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Address Line | 205 VESTA CT
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City | SURF CITY
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State | NC
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Zip | 28445-6546
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Country | US
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Telephone | 910-620-1967
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5010179
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License Number State | NC
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