Provider Demographics
NPI:1588213193
Name:DICKINSON, CHRISTINE LUCIE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LUCIE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:LUCIE
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2115 S FREMONT AVE STE 2900
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2233
Mailing Address - Country:US
Mailing Address - Phone:417-820-3535
Mailing Address - Fax:
Practice Address - Street 1:2115 S FREMONT AVE STE 2900
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2233
Practice Address - Country:US
Practice Address - Phone:417-820-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015020184163W00000X
MO2019038980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse