Individual
DIXIE AUTUM ROCHESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN, NP
Contact information
Practice address
703 S FLEISHEL AVE, STE 5000, TYLER, TX 75701-2015
(903) 606-2830
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
679723
TX
363L00000X
Nurse Practitioner
Primary
AP115010
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190351005
—
TX
05
—
190351006
—
TX
01
—
45-5720165
TRICARE
TX
01
—
75-2616977-120
TRICARE
TX
01
—
75-2616977-123
TRICARE
TX
01
—
8748MC
BCBS
TX
01
—
8858NH
BCBS
TX
Enumeration date
07/24/2006
Last updated
07/11/2024
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