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Individual

MS. CLARICE Y. DICKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.- C.

Contact information

Practice address
2161 LEXINGTON RD, 1ST FLOOR, SUITE 5, RICHMOND, KY 40475-7952
(859) 626-7794
(859) 626-4420
Mailing address
2161 LEXINGTON RD, RICHMOND, KY 40475-7952
(859) 626-7794
(859) 626-4420

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA460
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
183935
GROUP MEDICARE
KY
01
35001775
GROUP MEDICAID
KY
05
95901005
KY
Enumeration date
06/02/2005
Last updated
02/01/2016
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