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NPI Code Detail

MEDICARE: KIMBERLY DICKERSON

MEDICARE: KIMBERLY DICKERSON
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
1171M00000XCase Manager/Care Coordinator
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1942133368
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DICKERSON
Provider Business Mailing Address
First Line : 3500 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2641
Country : US
Telephone Number : 440-260-6835
Fax Number :
Provider Business Practice Location Address
First Line : 3500 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2641
Country : US
Telephone Number : 440-260-6835
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “ KIMBERLY DICKERSON ” Practice Location

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