Provider Demographics
NPI:1447490487
Name:DIXON, YVONDA L
Entity type:Individual
Prefix:MS
First Name:YVONDA
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 22754
Mailing Address - Street 2:SPECIAL MEDICAL CARE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252
Mailing Address - Country:US
Mailing Address - Phone:502-962-8200
Mailing Address - Fax:502-290-1193
Practice Address - Street 1:7808 PEARVIEW LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-962-8200
Practice Address - Fax:502-290-1193
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health