Provider Demographics
NPI:1184286734
Name:DIXON, KRISTYN MICHELLE (AUD)
Entity type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:MICHELLE
Last Name:DIXON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KRISTYN
Other - Middle Name:MICHELLE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3105 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4402
Mailing Address - Country:US
Mailing Address - Phone:918-508-7601
Mailing Address - Fax:918-508-7603
Practice Address - Street 1:3105 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4402
Practice Address - Country:US
Practice Address - Phone:918-508-7601
Practice Address - Fax:918-508-7603
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5210231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist