Jacqueline Veronica Dixon, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Garrison, NY
NPI 1083971907 · NPPES record last updated Feb 22, 2021
Key facts
- NPI
- 1083971907
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 401493 (NY)
- Practice address
- 21 Fraciscan Way
150 Graymoor
Garrison, NY 10524 - Phone
- (845) 335-1000
- NPI assigned
- Apr 17, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160321002253 | NY | Practitioner - Nurse Practitioner | 3375840226 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 401493 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Slope Center for Mental Health, Inc | Current |
Accepting new patients | |
| Montefiore Nyack Hospital | Current |
Accepting new patients | |
| Montefiore Nyack Hospital | Current |
Accepting new patients |
Locations
348 13th St
Ste 203
Brooklyn, NY 11215
Phone (718) 788-5101
160 N Midland Ave
Nyack, NY 10960
Phone (845) 348-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 401493 | NY | Yes |
Addresses
Primary practice location
21 Fraciscan Way
150 Graymoor
Garrison, NY 10524
Mailing address
4755 White Plains Rd Apt 2C
Bronx, NY 10470-1105
Other providers in Garrison, NY
- Danielle Elaine Chiaravalloti
- Helga G Coiro
- Cold Spring Physical Therapy PC
- Frederick L Debarros
- Yara P Desouza
- Mirjana Dorozan
- Barbara Downey-Goldwasser
- Darrell Dwyer
- Janet Eisig
- Alberto Espinosa
All providers in Garrison, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.