Healthcare Provider Details

I. General information

NPI: 1770231508
Provider Name (Legal Business Name): LAUREN TOLES DICKISON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 PINE LAKE DR NW
ARAB AL
35016-4536
US

IV. Provider business mailing address

2160 PINE LAKE DR NW
ARAB AL
35016-4536
US

V. Phone/Fax

Practice location:
  • Phone: 256-640-6291
  • Fax:
Mailing address:
  • Phone: 256-640-6291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberC-APN.0103698-C-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-162892
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: