Penny West Dickerson, RD
Individual provider Active NPI Registered Dietitian · Choctaw, MS
NPI 1073369658 · NPPES record last updated Apr 25, 2024
Key facts
- NPI
- 1073369658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- D-0579 (MS)
- Practice address
- 210 Hospital Cir
Choctaw, MS 39350-6781 - Phone
- (601) 389-4132
- NPI assigned
- Apr 25, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-0579 | MS | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-0579 | MS | Yes |
Addresses
Primary practice location
210 Hospital Cir
Choctaw, MS 39350-6781
Mailing address
210 Hospital Cir
Choctaw, MS 39350-6781
Phone (601) 389-4132
Other providers in Choctaw, MS
- Marjorie Britt
- Natalie A Byram
- Choctaw Health Center Pharmacy
- Steven Kory Culpepper
- Teresa K. Cumberland
- Philip Evans
- William Gregory Evans
- Kardarius Felton
- Adrienne Sisson Fulton
- Katlyn Goodin
All providers in Choctaw, MS · Registered Dietitian in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.