1659037570 NPI number — MISS SHAMERYL JASMINE DIXON ALC

Table of content: MISS SHAMERYL JASMINE DIXON ALC (NPI 1659037570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659037570 NPI number — MISS SHAMERYL JASMINE DIXON ALC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
SHAMERYL
Provider Middle Name:
JASMINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ALC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659037570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3929 AIRPORT BOULEVARD
Provider Second Line Business Mailing Address:
BUILDING 3, SUITE 310
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-414-3599
Provider Business Mailing Address Fax Number:
251-217-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3929 AIRPORT BOULEVARD
Provider Second Line Business Practice Location Address:
BUILDING 3, SUITE 310
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-414-3599
Provider Business Practice Location Address Fax Number:
251-217-4624
Provider Enumeration Date:
11/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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