MEDICARE: TAMARA DICKINSON AGNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	AP133440	TX

General Provider Information

NPI Number	:	1063952851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA DICKINSON AGNP

Provider Business Mailing Address
First Line	:	5801 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6403
Country	:	US
Telephone Number	:	214-645-8301
Fax Number	:	214-645-7622

Provider Business Practice Location Address
First Line	:	5801 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6403
Country	:	US
Telephone Number	:	214-645-8301
Fax Number	:	214-645-7622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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