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General NPI Number Information
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NPI Number | 1093599276
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Entity Type | Individual
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Provider Name | HEATHER A DICKERSON NP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 5921 W STATE ROAD 46
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City | BLOOMINGTON
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State | IN
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Zip | 47404-9359
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Country | US
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Telephone | 812-835-8866
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Fax |
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Provider Business Mailing Address
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Address Line | 5319 MISTHAVEN LN
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City | GREENWOOD
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State | IN
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Zip | 46143-6262
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Country | US
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Telephone | 317-370-7744
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Fax | 317-370-7744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28179813A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71014255A
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License Number State | IN
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