Provider Demographics
NPI:1972007698
Name:DICKEY, AMY KRISTEN-LEE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTEN-LEE
Last Name:DICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71061-1037
Mailing Address - Country:US
Mailing Address - Phone:318-564-2503
Mailing Address - Fax:318-636-4194
Practice Address - Street 1:3510 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:305-299-5152
Practice Address - Fax:318-636-4196
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator