Provider Demographics
NPI:1013330141
Name:DICKERSON, ERIN (FNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 KIRBY PKWY
Mailing Address - Street 2:STE 202
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3696
Mailing Address - Country:US
Mailing Address - Phone:901-751-9997
Mailing Address - Fax:901-751-1344
Practice Address - Street 1:1920 KIRBY PKWY
Practice Address - Street 2:STE 202
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3696
Practice Address - Country:US
Practice Address - Phone:901-751-9997
Practice Address - Fax:901-751-1344
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5631364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health