Provider Demographics
NPI:1881142008
Name:DICKINS, KIRSTEN (APN)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:DICKINS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MONUMENT RD STE 600
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1701
Mailing Address - Country:US
Mailing Address - Phone:610-617-2415
Mailing Address - Fax:215-893-5560
Practice Address - Street 1:150 MONUMENT RD STE 600
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1701
Practice Address - Country:US
Practice Address - Phone:610-617-2415
Practice Address - Fax:215-893-5560
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2332917363L00000X
IL209.014679363L00000X
PASP032251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner