Individual
HEATHER A DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5921 W STATE ROAD 46, BLOOMINGTON, IN 47404-9359
(812) 835-8866
Mailing address
5319 MISTHAVEN LN, GREENWOOD, IN 46143-6262
(317) 370-7744
(317) 370-7744
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
28179813A
IN
363LF0000X
Family Nurse Practitioner
Primary
71014255A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300082939
—
IN
Enumeration date
08/21/2023
Last updated
12/04/2023
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