Provider Demographics
NPI:1023814415
Name:DIXON, TEVIN
Entity type:Individual
Prefix:
First Name:TEVIN
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 BENSON GARDENS BLVD APT 1C
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6740
Mailing Address - Country:US
Mailing Address - Phone:402-810-0710
Mailing Address - Fax:
Practice Address - Street 1:7925 S 157TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1177
Practice Address - Country:US
Practice Address - Phone:402-210-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE175T00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No175T00000XOther Service ProvidersPeer Specialist