Dixon Correctional Institute

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

AP07348 Issued in LA

Legal business name

DIXON CORRECTIONAL INSTITUTE

Practice address

5085 Creek Valley Dr
Zachary, LA 70791-3073

Phone

(225) 610-7403

NPI assigned

Sep 19, 2013

Organization subpart

No

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

Authorized official

Name

Angelo Anthony Tarver, M.D.

Title

Medical Director

Phone

(225) 634-6311

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1558797639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5085 CREEK VALLEY DR",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "70791",
            "telephone_number": "225-610-7403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5085 CREEK VALLEY DR",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707913073",
            "telephone_number": "225-610-7403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXON CORRECTIONAL INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "TARVER",
        "authorized_official_first_name": "ANGELO",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "225-634-6311",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "LA",
            "license": "AP07348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Sue Denham, MPT
• Mary K Deranger, PT
• Denise Ann Deselle, ATR-BC, LPC
• Denise Diaz
• Elana Lee Dickson, SLP
• Amy B Dixon, OTR
• Keely Head Donaldson, OT
• Double DS Transport LLC
• Ashlei Rae Douglas
• Dpi Pain Management LLC

• Clinic/Center in Zachary, LA
• Providers in Zachary, LA by specialty
• Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.