MEDICARE: MS. ALEXANDRIA DELYNN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	D.007156-C1	AL

General Provider Information

NPI Number	:	1932849973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXANDRIA DELYNN DIXON

Provider Business Mailing Address
First Line	:	5257 JUDY LYNN CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-2547
Country	:	US
Telephone Number	:	901-598-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	5257 JUDY LYNN CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-2547
Country	:	US
Telephone Number	:	901-598-6371
Fax Number	:

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

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	05/24/2023

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