Healthcare Provider Details

I. General information

NPI: 1386442937
Provider Name (Legal Business Name): ROSETTA L DICKEY CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSEY L DICKEY CPRS

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 PARLIAMENT PL APT 96
KETTERING OH
45429-4334
US

IV. Provider business mailing address

3965 PARLIAMENT PL APT 96
KETTERING OH
45429-4334
US

V. Phone/Fax

Practice location:
  • Phone: 937-510-8310
  • Fax:
Mailing address:
  • Phone: 937-510-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006069
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: