Provider Demographics
NPI:1366476392
Name:DICKERSON, VALERIE SHEPHARD (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:SHEPHARD
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4540
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4540
Mailing Address - Country:US
Mailing Address - Phone:775-882-0430
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:925 IRONWOOD DR
Practice Address - Street 2:SUITE 2102
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-5178
Practice Address - Country:US
Practice Address - Phone:775-445-7745
Practice Address - Fax:775-782-0073
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8EB641Medicare PIN