Individual
MR. RICHARD TIMOTHY DICKERSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
315 W 15TH ST, SWMC - ANESTHESIA, LIBERAL, KS 67901-2455
(620) 629-6682
Mailing address
315 W 15TH ST, SWMC - ANESTHESIA, LIBERAL, KS 67901-2455
(620) 629-6682
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1-08001
AL
367500000X
Certified Registered Nurse Anesthetist
199844
CO
367500000X
Certified Registered Nurse Anesthetist
Primary
55580
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
999999
—
AL
Enumeration date
11/28/2006
Last updated
05/24/2013
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