Basic Information
| Provider Information | |||||||||
| NPI: | 1972007698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKEY | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | KRISTEN-LEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1037 | ||||||||
| Address2: | |||||||||
| City: | OIL CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710611037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185642503 | ||||||||
| FaxNumber: | 3186364194 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 LINWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052995152 | ||||||||
| FaxNumber: | 3186364196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2018 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.