Dickerson, Jacob Edward

Dickerson, Jacob Edward is an sole proprietor health care provider with primary practice located at 100 S Bliss Ave , Tahlequah OK 74464-2512. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Dickerson, Jacob Edward can be contacted via phone (918) 458-3100.

Contact Information

Primary practice address
100 S Bliss Ave Tahlequah OK 74464-2512
Phone: (918) 458-3100
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 208980 Oklahoma

Profile Details

NPI number 1013659960
LBN Legal business name Dickerson, Jacob Edward
Credentials DNAP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 11th, 2022
Last updated Jul 10th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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