Provider Demographics
NPI:1831330067
Name:APEX HEALTHCARE,
Entity type:Organization
Organization Name:APEX HEALTHCARE,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:DENIS
Authorized Official - Last Name:DICKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, BC
Authorized Official - Phone:423-247-8811
Mailing Address - Street 1:208 LYNN GARDEN DR.
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3191
Mailing Address - Country:US
Mailing Address - Phone:423-247-8811
Mailing Address - Fax:423-247-6207
Practice Address - Street 1:208 LYNN GARDEN DR.
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3191
Practice Address - Country:US
Practice Address - Phone:423-247-8811
Practice Address - Fax:423-247-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD42820207Q00000X
TN19265207Q00000X
TN7650363LF0000X
TN10969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517960Medicaid
TN1517960Medicaid