Individual
MS. SARA MARIE DICKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6650 EASTGATE BLVD STE 104, LEBANON, TN 37090-6018
(615) 453-9492
(615) 453-9498
Mailing address
6650 EASTGATE BLVD STE 104, LEBANON, TN 37090-6018
(615) 900-5451
(615) 900-5440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2842
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q031810
—
TN
Enumeration date
10/03/2005
Last updated
01/21/2022
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