MEDICARE: DR. JENNIFER LYNN HIXSON LP, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS016805	PA
2	103T00000X	Psychologist	P 3113	TN
3	103TC0700X	Clinical Psychologist	2013027928	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	856921	OTHER	KS	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11759293	OTHER		CAQH

General Provider Information

NPI Number	:	1033230917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LYNN HIXSON LP, BCBA

Provider Business Mailing Address
First Line	:	2128 PONTY POOL DR
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-7455
Country	:	US
Telephone Number	:	254-290-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 PONTY POOL DR
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-7455
Country	:	US
Telephone Number	:	615-754-1213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	12/10/2013

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