Individual
DR. JENNIFER LYNN HIXSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP, BCBA
Contact information
Practice address
2128 PONTY POOL DR, MOUNT JULIET, TN 37122-7455
(615) 754-1213
Mailing address
2128 PONTY POOL DR, MOUNT JULIET, TN 37122-7455
(254) 290-4048
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P 3113
TN
103TC0700X
Clinical Psychologist
2013027928
MO
103TC0700X
Clinical Psychologist
PS016805
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11759293
CAQH
—
05
—
200437120A
—
KS
01
—
856921
BCBS
KS
Enumeration date
04/02/2007
Last updated
12/10/2013
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