Provider Demographics
NPI:1770255051
Name:DICKMEYER, ALISHA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHELLE
Last Name:DICKMEYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:MICHELLE
Other - Last Name:KUHLENHOELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11220 ROLLING PINE RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-8119
Mailing Address - Country:US
Mailing Address - Phone:812-459-6162
Mailing Address - Fax:
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:877-774-8632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003245A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant