Healthcare Provider Details

I. General information

NPI: 1407780620
Provider Name (Legal Business Name): ABIGAIL LOUISE DICKENS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 12TH AVE S
BUFFALO MN
55313-2305
US

IV. Provider business mailing address

411 3RD ST N
WAITE PARK MN
56387-1177
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-4400
  • Fax: 763-682-1353
Mailing address:
  • Phone: 320-230-0611
  • Fax: 763-682-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2464095
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14458
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: