Individual
MICHELLE GOMEZ DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1818 COLLEGE DRIVE, MERIDIAN, MS 39307
(601) 581-7974
Mailing address
PO BOX 4128, MERIDIAN, MS 39304-4128
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
876648
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
904508
MS
Other
Enumeration date
09/22/2020
Last updated
03/21/2021
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