Healthcare Provider Details

I. General information

NPI: 1891304564
Provider Name (Legal Business Name): WHITNEY ANNE DICKERSON APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY DICKERSON

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 03/06/2024
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 S MAIN ST
FORT SCOTT KS
66701-3026
US

IV. Provider business mailing address

PO BOX 1832
PITTSBURG KS
66762-1832
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-9170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80316
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021021278
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019007730
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number130840
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: