Healthcare Provider Details

I. General information

NPI: 1447037668
Provider Name (Legal Business Name): AMY HARRELSON DICKINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5772 JACKSON CREEK RD
DENTON NC
27239-9264
US

IV. Provider business mailing address

5501 FORTUNES RIDGE DR STE P
DURHAM NC
27713-6102
US

V. Phone/Fax

Practice location:
  • Phone: 336-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: