Provider Demographics
NPI:1275325615
Name:DIX, KIMBERLY ROSE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROSE
Last Name:DIX
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 1:2126A HARKINS RD
Mailing Address - Street 2:
Mailing Address - City:PYLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21132-1615
Mailing Address - Country:US
Mailing Address - Phone:443-527-5700
Mailing Address - Fax:
Practice Address - Street 1:2126A HARKINS RD
Practice Address - Street 2:
Practice Address - City:PYLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21132-1615
Practice Address - Country:US
Practice Address - Phone:443-527-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily