MEDICARE: LORI DICKENS MSN, PMHNP-BC, APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5023887	NC

General Provider Information

NPI Number	:	1689524324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI DICKENS MSN, PMHNP-BC, APRN

Provider Business Mailing Address
First Line	:	1217 BETHLEHEM RD
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-9325
Country	:	US
Telephone Number	:	919-971-7386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NW MAYNARD RD STE 140
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-8707
Country	:	US
Telephone Number	:	984-341-0531
Fax Number	:	919-704-3674

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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