Provider Demographics
NPI:1770781056
Name:DICKSON, LORI ANN (APN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:DICKSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4647
Mailing Address - Country:US
Mailing Address - Phone:931-820-0242
Mailing Address - Fax:833-551-4830
Practice Address - Street 1:1015 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2450
Practice Address - Country:US
Practice Address - Phone:615-895-3233
Practice Address - Fax:615-895-4119
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TNAPN0000016674363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1035785I50Medicare PIN
TN1035I07266Medicare PIN