Provider Demographics
NPI:1568434173
Name:DICKERSON, CAROL ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 STATE LINE RD
Mailing Address - Street 2:#100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2025
Mailing Address - Country:US
Mailing Address - Phone:816-276-6450
Mailing Address - Fax:816-276-6455
Practice Address - Street 1:11661 COLLEGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4104
Practice Address - Country:US
Practice Address - Phone:816-276-6450
Practice Address - Fax:816-276-6455
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104716363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology