Provider Demographics
NPI:1356016497
Name:DICKSON, MACY JOHNSON (FNP)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:JOHNSON
Last Name:DICKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:RENEE'
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 LOWER CREEK DR NE
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4433
Mailing Address - Country:US
Mailing Address - Phone:828-612-4218
Mailing Address - Fax:
Practice Address - Street 1:160 RIVER BEND DR STE A
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-9371
Practice Address - Country:US
Practice Address - Phone:828-757-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty