Provider Demographics
NPI:1497938856
Name:DICKISON, ESTHER MYRNETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:MYRNETTE
Last Name:DICKISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5469 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1928
Mailing Address - Country:US
Mailing Address - Phone:901-761-0021
Mailing Address - Fax:901-255-2823
Practice Address - Street 1:5469 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1928
Practice Address - Country:US
Practice Address - Phone:901-761-0021
Practice Address - Fax:901-255-2823
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1240172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker