Individual
TAMIKA DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
412 7TH ST, KENTWOOD, LA 70444-2308
(985) 503-7501
Mailing address
412 7TH ST, KENTWOOD, LA 70444-2308
(985) 503-7501
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
801108471
MS
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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