Healthcare Provider Details

I. General information

NPI: 1689724437
Provider Name (Legal Business Name): DAVID ALAN DICKEY CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS ROAD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6 W ATTN THERESA BROOKS
ROCKVILLE MD
20853
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-7664
  • Fax: 703-490-7795
Mailing address:
  • Phone: 301-816-2414
  • Fax: 301-388-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024131738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: