Provider Demographics
NPI:1386095313
Name:HIXSON, JENNIFER ERIN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:HIXSON
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 1:123 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4227
Mailing Address - Country:US
Mailing Address - Phone:406-247-3350
Mailing Address - Fax:406-247-3389
Practice Address - Street 1:123 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4227
Practice Address - Country:US
Practice Address - Phone:406-247-3350
Practice Address - Fax:406-247-3389
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-RES-LIC-67440390200000X
MT100401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program