Provider Demographics
NPI:1265286801
Name:DICKINSON, EMILY ELIZABETH (PA-C, CHI)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:PA-C, CHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 MEADOWLARK CIR SE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6019
Mailing Address - Country:US
Mailing Address - Phone:217-722-6078
Mailing Address - Fax:
Practice Address - Street 1:920 CHURCH ST N STE 255
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171R00000XOther Service ProvidersInterpreter
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program