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NPI Code Detail

MEDICARE: MS. KAITLYN DICKERT PA-C

MEDICARE: MS. KAITLYN DICKERT PA-C
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
1133V00000XRegistered DietitianND7665FL
2363AM0700XMedical Physician Assistant9112407FL

General Provider Information

NPI Number : 1396102307
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KAITLYN DICKERT PA-C
Provider Business Mailing Address
First Line : 1250 N VANTAGE POINT DR
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5736
Country : US
Telephone Number : 352-795-0644
Fax Number :
Provider Business Practice Location Address
First Line : 1250 N VANTAGE POINT DR
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5736
Country : US
Telephone Number : 352-795-0644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2016
Last Update Date : 03/05/2020

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