Healthcare Provider Details

I. General information

NPI: 1457937484
Provider Name (Legal Business Name): KATIE DICK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

305 LANGDON ST
SOMERSET KY
42503-2750
US

V. Phone/Fax

Practice location:
  • Phone: 270-566-2763
  • Fax:
Mailing address:
  • Phone: 270-566-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number06370
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: