Provider Demographics
NPI:1902431877
Name:DIXON, KEYANTE JAQUA
Entity Type:Individual
Prefix:
First Name:KEYANTE
Middle Name:JAQUA
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 1:3851 SAINT BARNABAS RD APT T2
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3239
Mailing Address - Country:US
Mailing Address - Phone:202-892-9440
Mailing Address - Fax:
Practice Address - Street 1:3851 SAINT BARNABAS RD APT T2
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-3239
Practice Address - Country:US
Practice Address - Phone:202-892-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider