Individual
REBECCA RAE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
12060 COUNTY LINE RD, SUITE D, MADISON, AL 35756-2003
(256) 232-0475
(256) 232-0429
Mailing address
12060 COUNTY LINE RD, SUITE D, MADISON, AL 35756-2003
(256) 232-0475
(256) 232-0429
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-093181
AL
363LP0200X
Pediatric Nurse Practitioner
1-093181
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110708
—
AL
Enumeration date
03/24/2009
Last updated
03/12/2012
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