Provider Demographics
NPI:1154292845
Name:DIXON-GREEN, VERLISA
Entity type:Individual
Prefix:MRS
First Name:VERLISA
Middle Name:
Last Name:DIXON-GREEN
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 1:3741 FAIRHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1317
Mailing Address - Country:US
Mailing Address - Phone:817-600-5752
Mailing Address - Fax:
Practice Address - Street 1:3741 FAIRHAVEN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1317
Practice Address - Country:US
Practice Address - Phone:817-600-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist