Healthcare Provider Details

I. General information

NPI: 1629162227
Provider Name (Legal Business Name): CHERI DENISE DICKENSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 INNOVATION DR STE 102
CHESAPEAKE VA
23320-3866
US

IV. Provider business mailing address

4600 MONTGOMERY RD
CINCINNATI OH
45212-2697
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone: 833-510-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPN00000010969
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024166505
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024166505
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: