Individual
KAREN DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1352 E CENTER ST, POCATELLO, ID 83201-4734
(208) 234-2001
(208) 232-2195
Mailing address
PO BOX O, POCATELLO, ID 83205-0049
(208) 234-2001
(208) 232-2195
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA566
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8073207000
—
ID
Enumeration date
08/20/2006
Last updated
07/08/2007
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