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NPI Code Detail

MEDICARE: KIRAH L DICKERSON CHW-C

MEDICARE: KIRAH L DICKERSON CHW-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2172V00000XCommunity Health WorkerMO

General Provider Information

NPI Number : 1578391199
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRAH L DICKERSON CHW-C
Provider Business Mailing Address
First Line : 9231 W FLORISSANT AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-1422
Country : US
Telephone Number : 314-504-4706
Fax Number :
Provider Business Practice Location Address
First Line : 9231 W FLORISSANT AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-1422
Country : US
Telephone Number : 314-504-4706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2024
Last Update Date : 07/24/2024

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Directions to “ KIRAH L DICKERSON CHW-C” Practice Location

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