Provider Demographics
NPI:1134376213
Name:DICKINSON, JOE PETE (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:PETE
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:FNP-C
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 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-454-3025
Mailing Address - Fax:903-450-1408
Practice Address - Street 1:111 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2103
Practice Address - Country:US
Practice Address - Phone:903-454-3025
Practice Address - Fax:903-450-1408
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351622ZJSUMedicare PIN