Healthcare Provider Details

I. General information

NPI: 1235065491
Provider Name (Legal Business Name): AMY E DICKERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17581 W 83RD PL
ARVADA CO
80007-6877
US

IV. Provider business mailing address

17581 W 83RD PL
ARVADA CO
80007-6877
US

V. Phone/Fax

Practice location:
  • Phone: 720-737-9639
  • Fax:
Mailing address:
  • Phone: 720-737-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number261QU0200X
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: