Provider Demographics
NPI:1871890301
Name:DICKENS, KASSANDRA A (CRNP)
Entity type:Individual
Prefix:MS
First Name:KASSANDRA
Middle Name:A
Last Name:DICKENS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 WINTER PINE TRL
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1506
Mailing Address - Country:US
Mailing Address - Phone:301-675-6471
Mailing Address - Fax:410-832-5766
Practice Address - Street 1:1417 WINTER PINE TRL
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1506
Practice Address - Country:US
Practice Address - Phone:301-675-6471
Practice Address - Fax:410-832-5766
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163196363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9115660OtherAETNA PPO
MD6602616OtherAETNA HMO
MD246893OtherEHP/PRIORITY PARTNERS
MDP00936839OtherRAILROAD MEDICARE
MD0114OtherCAREFIRST BCBS BLUECHOICE
MD553221300Medicaid
MD97285701OtherCAREFIRST BCBS OF MD
MDP00936839OtherRAILROAD MEDICARE