Individual
KAYLA NICOLE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24978 MS HIGHWAY 15, MATHISTON, MS 39752-6904
(662) 634-3089
(662) 634-3063
Mailing address
24978 MS HIGHWAY 15, MATHISTON, MS 39752-6904
(662) 634-3089
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
907244
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
907244
STATE LICENSE
MS
Enumeration date
02/07/2025
Last updated
03/04/2025
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