Healthcare Provider Details

I. General information

NPI: 1275516494
Provider Name (Legal Business Name): JAMES EDWIN DICKEY FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36105 REEF DR
KENAI AK
99611-8767
US

IV. Provider business mailing address

36105 REEF DR
KENAI AK
99611-8767
US

V. Phone/Fax

Practice location:
  • Phone: 907-330-9006
  • Fax:
Mailing address:
  • Phone: 907-330-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7700-162
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: