Provider Demographics
NPI:1366209272
Name:LIVINGSTON, DAWN RAE
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RAE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 PYEATT DR
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-7842
Mailing Address - Country:US
Mailing Address - Phone:903-239-3239
Mailing Address - Fax:
Practice Address - Street 1:523 S FANNIN AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8204
Practice Address - Country:US
Practice Address - Phone:903-535-9041
Practice Address - Fax:903-630-2039
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154514363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty