Provider Demographics
NPI:1386943835
Name:DICKERSON, KATHRYN ELYSE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELYSE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-2382
Mailing Address - Fax:214-456-6133
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-456-2382
Practice Address - Fax:214-456-6133
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR20822080P0207X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty