Nichole Ann Dickerson, QMHS, CMS

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

111 S Broad St Ste 209
Lancaster, OH 43130-4383

Phone

(888) 522-9174

NPI assigned

Jun 10, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ohioguidestone

  • Community/Behavioral Health Agency
  • Berea, OH
  • NPI 1295096758
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1043949340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 EASTLAND RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S BROAD ST STE 209",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431304383",
            "telephone_number": "888-522-9174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "NICHOLE",
        "middle_name": "ANN",
        "credential": "QMHS, CMS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry William Detwiler, DDS
• Jon P Detwiler, DDS
• Prithvia Rachel Devadas, DO
• Kristen Deye, LPC
• Andrea Lyn Dickerson, LPN
• Jacob J Dickey
• Sandra Dickey, HHA
• Evan Eugene Diehl
• Allison Dietz, MSW, LISW
• Digestive Medical Services, Inc

• Community Health Worker in Lancaster, OH
• Providers in Lancaster, OH by specialty
• Community Health Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.