Individual
KELCIE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5799
(208) 814-1440
(208) 814-1924
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1345
ID
363A00000X
Physician Assistant
Primary
PT607
WY
Other
Enumeration date
08/29/2014
Last updated
07/23/2026
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