Provider Demographics
NPI:1295764652
Name:DICKENS, DAVID R (CNS-P/MH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DICKENS
Suffix:
Gender:M
Credentials:CNS-P/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 E STAN SCHLUETER LOOP STE 202
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4554
Mailing Address - Country:US
Mailing Address - Phone:254-634-4244
Mailing Address - Fax:254-634-8809
Practice Address - Street 1:3901 E STAN SCHLUETER LOOP STE 202
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4554
Practice Address - Country:US
Practice Address - Phone:254-634-4244
Practice Address - Fax:254-634-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508035163WP0808X
TXAP102066364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096202902Medicaid
TXS52771Medicare UPIN
TXCN0037Medicare ID - Type Unspecified