Provider Demographics
NPI:1710661095
Name:DICKS, CHRISTIAN ALEXENDRIA (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ALEXENDRIA
Last Name:DICKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-2942
Mailing Address - Country:US
Mailing Address - Phone:864-226-3427
Mailing Address - Fax:
Practice Address - Street 1:208 JAMES ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2942
Practice Address - Country:US
Practice Address - Phone:864-226-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily