Individual provider Active NPI

Brenda Carol Dixon, ARNP

  • Women's Health Nurse Practitioner
  • Fort Walton Beach, FL
National Provider Identifier
1073573945
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
ARNP1736202 Issued in FL
Practice address
221 Hospital Dr NE
Fort Walton Beach, FL 32548-5066
Phone
(850) 833-9240
Fax
(850) 833-9252
NPI assigned
Mar 24, 2006
Last updated
Dec 6, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X ARNP1736202 FL Primary

Addresses

Primary practice location

221 Hospital Dr NE
Fort Walton Beach, FL 32548-5066

Mailing address

221 Hospital Dr NE
Fort Walton Beach, FL 32548-5066
Phone (850) 833-9240

Other identifiers 1

IdentifierTypeStateIssuer
301660900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111216000341 FL Practitioner - Nurse Practitioner 8022283290 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Department of Health CurrentSince Jul 1, 1999 Accepting new patients
Florida Department of Health CurrentSince Jul 1, 1999 Accepting new patients

Locations

810 E James Lee Blvd
Crestview, FL 32539
Phone (850) 689-5593

221 Hospital Dr NE
Ft Walton Bch, FL 32548
Phone (850) 833-9233

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354752000000",
    "number": "1073573945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 HOSPITAL DR NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325485066",
            "telephone_number": "850-833-9240",
            "fax_number": "850-833-9252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 HOSPITAL DR NE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325485066",
            "telephone_number": "850-833-9240",
            "fax_number": "850-833-9252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIXON",
        "first_name": "BRENDA",
        "middle_name": "CAROL",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2012-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "FL",
            "license": "ARNP1736202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "301660900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.