Provider Demographics
NPI:1386970572
Name:DICKERHOFF, JAMIE POLING (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:POLING
Last Name:DICKERHOFF
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7979
Mailing Address - Country:US
Mailing Address - Phone:910-878-6700
Mailing Address - Fax:910-878-6705
Practice Address - Street 1:6322 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7979
Practice Address - Country:US
Practice Address - Phone:910-878-6700
Practice Address - Fax:910-878-6705
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00887113OtherRAILROAD MEDICARE
NC7000634Medicaid
NC7000634Medicaid