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Individual
DR. AMANDA RACHEL DICKERSON
Active
Individual
DR. AMANDA RACHEL DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1015398
MA
208000000X
Pediatrics Physician
2010021085
MO
390200000X
Student in an Organized Health Care Education/Training Program
2007017251
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376741249
—
MO
05
—
200295930A
—
OK
05
—
200658010A
—
KS
01
—
684702
ANTHEM
—
01
—
A24058
HEALTH LINK
—
Enumeration date
07/03/2007
Last updated
12/01/2023
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