Provider Demographics
NPI:1902351190
Name:DICKSON, KERI MARLENE (FNP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:MARLENE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-638-3444
Mailing Address - Fax:864-638-3445
Practice Address - Street 1:103 WHITETAIL DR
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-5837
Practice Address - Country:US
Practice Address - Phone:864-638-3444
Practice Address - Fax:864-638-3445
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily