MEDICARE: JAMI MAYORGA DICKSON NURSE PRACTIONER

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP119548	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	642611	OTHER	TX	TEXAS LICENSE

General Provider Information

NPI Number	:	1629386644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI MAYORGA DICKSON NURSE PRACTIONER

Provider Business Mailing Address
First Line	:	4072 BRIAR TREE LN
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-3868
Country	:	US
Telephone Number	:	972-712-0591
Fax Number	:	972-421-1527

Provider Business Practice Location Address
First Line	:	4324 MAPLESHADE LN STE 158
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-0050
Country	:	US
Telephone Number	:	972-712-0591
Fax Number	:	972-421-1527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	12/03/2025

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