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Individual

KANISHA CONRAD DICKENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
12 MOONSTONE CT, DURHAM, NC 27703-2682
(866) 654-1113
(919) 439-0222
Mailing address
12 MOONSTONE CT, DURHAM, NC 27703-1543
(866) 654-1113
(919) 439-0222

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
59949
NC
376G00000X
Nursing Home Administrator
FCL-032-122
NC

Other

Enumeration date
11/01/2012
Last updated
11/27/2023
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