Provider Demographics
NPI:1598508954
Name:DICKENS, SUSAN ALEXIS (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALEXIS
Last Name:DICKENS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ALEXIS
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1105 COUNTY ROAD 251
Mailing Address - Street 2:
Mailing Address - City:ETTA
Mailing Address - State:MS
Mailing Address - Zip Code:38627-9535
Mailing Address - Country:US
Mailing Address - Phone:662-816-3727
Mailing Address - Fax:
Practice Address - Street 1:1105 COUNTY ROAD 251
Practice Address - Street 2:
Practice Address - City:ETTA
Practice Address - State:MS
Practice Address - Zip Code:38627-9535
Practice Address - Country:US
Practice Address - Phone:662-816-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS900667163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management