Provider Demographics
NPI:1295952810
Name:DICKERSON, KARENNA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KARENNA
Middle Name:ANNE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:26672 PORTOLA PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1773
Mailing Address - Country:US
Mailing Address - Phone:949-829-5533
Mailing Address - Fax:949-581-9158
Practice Address - Street 1:26672 PORTOLA PKWY STE 108
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1773
Practice Address - Country:US
Practice Address - Phone:949-829-5533
Practice Address - Fax:949-581-9158
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2025-08-08
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Provider Licenses
StateLicense IDTaxonomies
CAC146775207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202300004Medicare PIN