Provider Demographics
NPI:1922306935
Name:DICKERSON, ALYSON LEE (CRNA)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:LEE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ALCORN DR
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9321
Mailing Address - Country:US
Mailing Address - Phone:662-293-1000
Mailing Address - Fax:662-293-4213
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-293-1000
Practice Address - Fax:662-293-4213
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869968367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered