Basic Information
| Provider Information | |||||||||
| NPI: | 1619966009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | DIXIE | ||||||||
| MiddleName: | ROUTON | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504763696 | ||||||||
| FaxNumber: | 8504773573 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 GRANDE DR | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504763696 | ||||||||
| FaxNumber: | 8504773573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | ARNP1762862 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 59088941 | 01 | FL | BCBS AL | OTHER | P00105273 | 01 | FL | MEDICARE RR | OTHER | Y017D | 01 | FL | BCBSFL | OTHER | 303385600 | 05 | FL | MEDICAID |