Provider Demographics
NPI:1407326028
Name:PAINTER, DIXIE ANN (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:ANN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:DIXIE
Other - Middle Name:ANN
Other - Last Name:PAINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:S: 1075 BETTERAVIA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-621-7651
Mailing Address - Fax:
Practice Address - Street 1:1075 E BETTERAVIA RD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7023
Practice Address - Country:US
Practice Address - Phone:805-621-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171M00000X, 171M00000X
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator