Provider Demographics
NPI:1295381069
Name:DICKEY, AMANDA GAYLE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAYLE
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 1:4715 HILTON CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4152
Mailing Address - Country:US
Mailing Address - Phone:614-647-2000
Mailing Address - Fax:
Practice Address - Street 1:4715 HILTON CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4152
Practice Address - Country:US
Practice Address - Phone:614-647-2000
Practice Address - Fax:828-287-4320
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007537RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNND290AOtherMEDICARE PIN