Provider Demographics
NPI:1447934526
Name:DICKERSON, MICHAEL RAY (DNP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8016 STATE LINE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8016 STATE LINE RD STE 205
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3713
Practice Address - Country:US
Practice Address - Phone:913-251-9207
Practice Address - Fax:913-243-2007
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS53-82295-122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily