Provider Demographics
NPI:1730198391
Name:REID, DIXIE JUNE (PA-C)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:JUNE
Last Name:REID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 N NEVADA AVE STE 2025
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:303-733-8848
Mailing Address - Fax:303-733-3107
Practice Address - Street 1:2222 N NEVADA AVE STE 2025
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:303-733-8848
Practice Address - Fax:303-733-3107
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2010-0001363AS0400X
OK2162363AS0400X
AZ8449363AS0400X
COPA.0006334363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09639829Medicaid