Provider Demographics
NPI:1154885531
Name:DIXON, KAYCEE NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:KAYCEE
Middle Name:NICOLE
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 RILEY DR
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-1623
Mailing Address - Country:US
Mailing Address - Phone:865-805-0612
Mailing Address - Fax:
Practice Address - Street 1:2946 WINFIELD DUNN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4316
Practice Address - Country:US
Practice Address - Phone:865-933-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily