Provider Demographics
NPI:1518195924
Name:DICKMAN, ADAM FRANCIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:FRANCIS
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 KENTUCKY AVE
Mailing Address - Street 2:DOB 3 SUITE 601
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3800
Mailing Address - Country:US
Mailing Address - Phone:270-408-4368
Mailing Address - Fax:270-408-3272
Practice Address - Street 1:2605 KENTUCKY AVE
Practice Address - Street 2:DOB 3 SUITE 601
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3800
Practice Address - Country:US
Practice Address - Phone:270-408-4368
Practice Address - Fax:270-408-3272
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1086041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1086041OtherMILITARY
KY1860OtherSTATE LICENSE