Provider Demographics
NPI:1861382764
Name:DIX, KILEY NICOLE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:NICOLE
Last Name:DIX
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PLUM DR
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-2458
Mailing Address - Country:US
Mailing Address - Phone:478-955-4723
Mailing Address - Fax:
Practice Address - Street 1:105 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6168
Practice Address - Country:US
Practice Address - Phone:478-559-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN308504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily