Healthcare Provider Details

I. General information

NPI: 1407068828
Provider Name (Legal Business Name): ROBERT BRUCE DICKINSON APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 NISSAN DR
SMYRNA TN
37167
US

IV. Provider business mailing address

PO BOX 28007
CHATTANOOGA TN
37424-8007
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-1944
  • Fax: 615-459-1944
Mailing address:
  • Phone: 615-830-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9316562
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8181
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60935771
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201706588NP-PP
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number8181
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number666869
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN177126
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number131381
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: