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Individual
MS. KELLY L DICKSON
Active
Individual
MS. KELLY L DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004679
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN004679
LICENSE NUMBER
—
Enumeration date
12/01/2011
Last updated
04/07/2022
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