MEDICARE: KENDRICK DIXON

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	343900000X	Non-emergency Medical Transport (VAN)		TX

General Provider Information

NPI Number	:	1134764756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRICK DIXON

Provider Business Mailing Address
First Line	:	6290 LUDINGTON DR APT 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-2336
Country	:	US
Telephone Number	:	832-704-4730
Fax Number	:

Provider Business Practice Location Address
First Line	:	6290 LUDINGTON DR APT 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-2336
Country	:	US
Telephone Number	:	832-704-4730
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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Directions to “ KENDRICK DIXON ” Practice Location

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