Individual
MRS. MICHELLE LEA DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 815-4790
(601) 984-6870
Mailing address
2500 NORTH STATE STREET, JMM ROOM 2525, JACKSON, MS 39216-4500
(601) 815-4790
(601) 984-6870
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R828866
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06626200
—
MS
Enumeration date
08/05/2007
Last updated
01/25/2017
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