MEDICARE: KATIE DICKEY 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
1	363A00000X	Physician Assistant	2123	OK

General Provider Information

NPI Number	:	1689947210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE DICKEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 405457
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-5457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20826 MAIN ST
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9756
Country	:	US
Telephone Number	:	405-605-5415
Fax Number	:

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

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	09/22/2015

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Directions to “ KATIE DICKEY PA-C” Practice Location

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