Provider Demographics
NPI:1689135949
Name:DICKERSON, ANESSA (CPM)
Entity Type:Individual
Prefix:MRS
First Name:ANESSA
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 HIGHLANDER TRL
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-5371
Mailing Address - Country:US
Mailing Address - Phone:731-610-0301
Mailing Address - Fax:
Practice Address - Street 1:999 LOLA WHITTEN RD
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-5350
Practice Address - Country:US
Practice Address - Phone:731-610-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife