Individual
KELLIE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
937 E 186TH ST, WESTFIELD, IN 46074-7827
(317) 804-8044
Mailing address
937 E 186TH ST, WESTFIELD, IN 46074-7827
(317) 804-8044
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
28237448A
IN
163WG0600X
Gerontology Registered Nurse
28237448A
IN
Other
Enumeration date
09/13/2021
Last updated
09/13/2021
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