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General NPI Number Information
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NPI Number | 1356016497
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Entity Type | Individual
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Provider Name | MACY JOHNSON DICKSON FNP
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Gender | Female
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 160 RIVER BEND DR STE A
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City | GRANITE FALLS
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State | NC
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Zip | 28630-9371
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Country | US
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Telephone | 828-757-5060
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Fax |
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Provider Business Mailing Address
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Address Line | 403 LOWER CREEK DR NE
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City | LENOIR
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State | NC
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Zip | 28645-4433
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Country | US
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Telephone | 828-612-4218
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5014866
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License Number State | NC
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