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General NPI Number Information
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NPI Number | 1124501630
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Entity Type | Individual
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Provider Name | KESLI ANNE DICKENS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1702 TACOMA AVE S STE A
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City | TACOMA
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State | WA
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Zip | 98402-1700
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Country | US
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Telephone | 877-522-1275
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Fax | 833-888-7145
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Provider Business Mailing Address
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Address Line | 500 SW 7TH ST STE A205
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City | RENTON
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State | WA
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Zip | 98057-2983
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Country | US
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Telephone | 877-522-1275
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 149515
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA61395609
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License Number State | WA
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