Individual
MARY C. DICKENS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1106 CENTRAL DR, SUITE 1, PHILADELPHIA, MS 39350-8972
(601) 656-6921
(601) 656-0381
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
(601) 703-9506
(601) 703-3264
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R703087
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01034524
—
MS
Enumeration date
11/20/2005
Last updated
07/08/2007
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