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General NPI Number Information
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NPI Number | 1871890301
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Entity Type | Individual
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Provider Name | KASSANDRA A DICKENS CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 1417 WINTER PINE TRL
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City | SEVERN
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State | MD
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Zip | 21144-1506
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Country | US
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Telephone | 301-675-6471
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Fax | 410-832-5766
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Provider Business Mailing Address
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Address Line | 1417 WINTER PINE TRL
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City | SEVERN
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State | MD
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Zip | 21144-1506
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Country | US
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Telephone | 301-675-6471
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Fax | 410-832-5766
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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 | R163196
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R163196
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License Number State | MD
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