Provider Demographics
NPI:1851865067
Name:DICKSON, JEFFERY THOMAS (FNP)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:THOMAS
Last Name:DICKSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 N MIDKIFF RD STE D6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4249
Mailing Address - Country:US
Mailing Address - Phone:432-704-5607
Mailing Address - Fax:
Practice Address - Street 1:4410 N MIDKIFF RD STE D6
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4249
Practice Address - Country:US
Practice Address - Phone:432-704-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine