1568434173 NPI number — CAROL ANN DICKERSON ARNP

Table of content: CAROL ANN DICKERSON ARNP (NPI 1568434173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568434173 NPI number — CAROL ANN DICKERSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKERSON
Provider First Name:
CAROL
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568434173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8301 STATE LINE RD
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64114-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-276-6450
Provider Business Mailing Address Fax Number:
816-276-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11661 COLLEGE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66210-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-276-6450
Provider Business Practice Location Address Fax Number:
816-276-6455
Provider Enumeration Date:
02/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  104716 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)