MEDICARE: DIXIE DEVER BLACKSTOCK DNP, RN

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	163WC0400X	Case Management Registered Nurse	687849	TX

General Provider Information

NPI Number	:	1134078694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIXIE DEVER BLACKSTOCK DNP, RN

Provider Business Mailing Address
First Line	:	11452 SPACE CENTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3599
Country	:	US
Telephone Number	:	713-486-6200
Fax Number	:	713-486-6294

Provider Business Practice Location Address
First Line	:	11452 SPACE CENTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3599
Country	:	US
Telephone Number	:	713-486-6200
Fax Number	:	713-486-6294

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

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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