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General NPI Number Information
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NPI Number | 1780903823
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Entity Type | Individual
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Provider Name | KELLY DIANNE DIXON CCC-AUDIOLOGY
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Gender | Female
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 2603 OSBORNE ST STE 1
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City | BRISTOL
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State | VA
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Zip | 24201-2326
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Country | US
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Telephone | 276-669-6331
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Fax | 276-669-2950
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Provider Business Mailing Address
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Address Line | 2603 OSBORNE ST SUITE 1
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City | BRISTOL
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State | VA
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Zip | 24201-2326
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Country | US
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Telephone | 276-669-6331
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Fax | 276-669-2950
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201001486
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1577
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License Number State | TN
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