Individual
MICHELLE R. DICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
927 E WAYSIDE PL, SPRINGFIELD, MO 65807-5357
(000) 000-0000
Mailing address
927 E WAYSIDE PL, SPRINGFIELD, MO 65807-5357
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
127598
MO
405300000X
Prevention Professional
127598
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861506610
—
MO
05
—
420749509
—
MO
Enumeration date
08/18/2006
Last updated
04/18/2023
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