# MRS. KELLY DIANNE DIXON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1780903823
- **Gender:** F
- **Credential:** CCC-AUDIOLOGY

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 1577 | TN | Yes |
| 231H00000X | Audiologist | 2201001486 | VA | — |

## Other

- **Enumeration date:** 05/28/2010
- **Last updated:** 04/05/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1577 | ST LIC | TN |
| 05 | — | 1780903823 | — | VA |
| 01 | — | 2201001486 | VA STATE LIC | VA |