Penny S Dixon, LMBT
Individual provider Active NPI Specialist · Eden, NC
NPI 1669698783 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1669698783
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 830 (NC)
- Practice address
- 323-D East Meadow Rd
Eden, NC 27288-3400 - Phone
- (336) 623-7400
- NPI assigned
- Apr 17, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 830 | NC | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Body & Face LLC | Past | Accepting new patients | |
| Eden Health & Wellness Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 830 | NC | Yes |
Addresses
Primary practice location
323-D East Meadow Rd
Eden, NC 27288-3400
Mailing address
323-D East Meadow Rd
Eden, NC 27288-3400
Phone (336) 623-7400
Other providers in Eden, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.