Provider Demographics
NPI:1861933954
Name:DIXON, SABRA L (PA-C)
Entity type:Individual
Prefix:
First Name:SABRA
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SABRA
Other - Middle Name:L
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:817-321-0404
Mailing Address - Fax:
Practice Address - Street 1:627 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1832
Practice Address - Country:US
Practice Address - Phone:903-593-2539
Practice Address - Fax:903-593-0559
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369735101Medicaid