Provider Demographics
NPI:1508254822
Name:DICKERSON, GETONYA TAYLOR (AGACNP)
Entity Type:Individual
Prefix:
First Name:GETONYA
Middle Name:TAYLOR
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 WATER BEND DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4620
Mailing Address - Country:US
Mailing Address - Phone:682-429-1340
Mailing Address - Fax:
Practice Address - Street 1:9309 WATER BEND DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4620
Practice Address - Country:US
Practice Address - Phone:682-429-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126934282N00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No282N00000XHospitalsGeneral Acute Care Hospital