Individual
JESSICA DIXON-TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
401 N 6TH ST, BUCKEYE, AZ 85326-2415
(623) 401-6331
(623) 233-6331
Mailing address
401 N 6TH ST, BUCKEYE, AZ 85326-2415
(623) 698-8210
(602) 455-4624
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LP040900
AZ
251E00000X
Home Health Agency
8900919
AZ
251J00000X
Nursing Care Agency
Primary
8900919
AZ
253J00000X
Foster Care Agency
8900919
AZ
385HR2055X
Child Mental Illness Respite Care
8900919
AZ
Other
Enumeration date
12/11/2019
Last updated
04/02/2025
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