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General NPI Number Information
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NPI Number | 1174797427
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Entity Type | Individual
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Provider Name | RACHEL ANNE DICKERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 111 PROSPECT AVE STE 202A
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City | KIRKWOOD
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State | MO
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Zip | 63122-6067
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Country | US
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Telephone | 314-394-2973
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Fax | 785-414-5373
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Provider Business Mailing Address
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Address Line | 111 PROSPECT AVE STE 202A
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City | KIRKWOOD
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State | MO
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Zip | 63122-6067
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Country | US
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Telephone | 314-394-2973
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Fax | 785-414-5373
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2012012812
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2012012812
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License Number State | MO
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