Individual
MS. KASSANDRA A DICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1417 WINTER PINE TRL, SEVERN, MD 21144-1506
(301) 675-6471
(410) 832-5766
Mailing address
1417 WINTER PINE TRL, SEVERN, MD 21144-1506
(301) 675-6471
(410) 832-5766
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R163196
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R163196
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0114
CAREFIRST BCBS BLUECHOICE
MD
01
—
246893
EHP/PRIORITY PARTNERS
MD
05
—
553221300
—
MD
01
—
6602616
AETNA HMO
MD
01
—
9115660
AETNA PPO
MD
01
—
97285701
CAREFIRST BCBS OF MD
MD
01
—
P00936839
RAILROAD MEDICARE
MD
Enumeration date
02/18/2011
Last updated
09/21/2022
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