Individual
KELCIE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3580 STATE HIGHWAY 414, LYMAN, WY 82937-0001
(307) 786-2042
(307) 786-4016
Mailing address
740 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5285
(208) 542-9111
(208) 542-9114
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PT607
WY
Other
Enumeration date
08/29/2014
Last updated
08/29/2014
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