Provider Demographics
NPI:1831712371
Name:DIKE, DICKSON
Entity type:Individual
Prefix:
First Name:DICKSON
Middle Name:
Last Name:DIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 DAIRY ASHFORD RD STE 560
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3035
Mailing Address - Country:US
Mailing Address - Phone:713-799-2200
Mailing Address - Fax:
Practice Address - Street 1:2323 BEDFORD OAK ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-7202
Practice Address - Country:US
Practice Address - Phone:832-513-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX989783163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse