Dickerson, Karen
Dickerson, Karen is an individual health care provider with primary practice located at 1352 E Center St , Pocatello ID 83201-4734. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Dickerson, Karen can be contacted via phone (208) 234-2001.Contact Information
Primary practice address
1352 E Center St
Pocatello ID 83201-4734
Phone: (208) 234-2001
Fax: (208) 232-2195
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA566 | Idaho |
Profile Details
| NPI number | 1760597462 |
|---|---|
| LBN Legal business name | Dickerson, Karen |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760597462 | NPPES |
| Idaho | MEDICAID | 8073207000 |
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