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General NPI Number Information
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NPI Number | 1033029749
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Entity Type | Organization
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Legal Business Name | DICKERSON WELLNESS
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 1830 S LAKE DR BOX 84432
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City | LEXINGTON
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State | SC
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Zip | 29073-9760
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Country | US
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Telephone | 803-477-4745
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Fax | 843-258-4600
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Provider Business Mailing Address
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Address Line | 1830 S LAKE DR BOX 84432
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City | LEXINGTON
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State | SC
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Zip | 29073-9760
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Country | US
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Telephone | 803-477-4745
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Fax | 843-258-4600
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. CHRISTINA JOCKLENE EDWARDS
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Credential | AGPCNP-C
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Telephone | 803-477-4745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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