Provider Demographics
NPI:1043674112
Name:DIXON, ALAN TYLER I (261155964 FSO)
Entity type:Individual
Prefix:MRS
First Name:ALAN
Middle Name:TYLER
Last Name:DIXON
Suffix:I
Gender:
Credentials:261155964 FSO
Other - Prefix:PROF
Other - First Name:PATHOS
Other - Middle Name:
Other - Last Name:CRESCENDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAF, PSD, LLC
Mailing Address - Street 1:611 MADISON ST APT 306
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4881
Mailing Address - Country:US
Mailing Address - Phone:615-719-0992
Mailing Address - Fax:
Practice Address - Street 1:611 MADISON ST UNIT 306
Practice Address - Street 2:ALIAH I
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3770
Practice Address - Country:US
Practice Address - Phone:615-719-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110154791744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN225600000XMedicaid
TN1043674112Medicaid
TN225600000XOtherUNITEDHEALTHCARE COMMUNITY PLAN
TN261155964OtherUNITED STATES DEPARTMENT OF STATES FOREIGN SERVICE & CONSULAR FELLOWS PROGRAM