Individual
STACEY D DICKENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20007
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721686
BCBS
—
01
—
2136163
UNITEDHEALTLHCARE
—
01
—
323741
CARELINK
—
05
—
54504
—
WV
05
—
58599
—
WV
05
—
6700460000
—
WV
01
—
G21540
HEALTH NET
—
Enumeration date
09/29/2006
Last updated
01/09/2025
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