Provider Demographics
NPI:1699070144
Name:DICKERSON, JEFFRY ALAN (FNP)
Entity type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:ALAN
Last Name:DICKERSON
Suffix:
Gender:M
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:P.O. BOX 117614
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-4422
Mailing Address - Country:US
Mailing Address - Phone:210-615-1901
Mailing Address - Fax:210-615-1905
Practice Address - Street 1:3903 WISEMAN BLVD, STE 311
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4422
Practice Address - Country:US
Practice Address - Phone:210-615-1901
Practice Address - Fax:210-615-1905
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP118266363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily