Jacqualine Drake Dickson, FNP - C
Individual provider Active NPI Family Nurse Practitioner · Collierville, TN
NPI 1124586995 · NPPES record last updated Feb 19, 2021
Key facts
- NPI
- 1124586995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APN0000024154 (TN)
- Practice address
- 526 Halle Park Dr
Collierville, TN 38017-7085 - Phone
- (901) 910-3246
- NPI assigned
- Mar 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
-
Margaret Henderson-Lee, FNP-BC
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Consolidated Medical Practices of Memphis,PLLC
Practice addresses (Care Compare)
6799 Great Oaks Rd
Suite 250
Memphis, TN 38138-2584
Phone (901) 261-0700
Hospital & facility affiliations
- Baptist Memorial Hospital
- Methodist Hospitals of Memphis
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190408001691 | TN | Practitioner - Nurse Practitioner | 0547501298 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 902387 | MS | MD | Family Nurse Practitioner |
| APN0000024154 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Internal Health and Medical Services LLC | Current | Accepting new patients | |
| Consolidated Medical Practices of Memphis,PLLC | Current |
Accepting new patients | |
| Margaret Lashun Henderson-Lee | Family | Past | Accepting new patients |
Locations
491 W Poplar Ave
Collierville, TN 38017
Phone (901) 286-4162
61 Peyton Pkwy
Collierville, TN 38017
Phone (901) 861-0031
526 Halle Park Dr
Collierville, TN 38017
Phone (901) 730-5345
2158 Judicial Dr
Memphis, TN 38138
Phone (901) 421-5174
6799 Great Oaks Rd
Ste 250
Memphis, TN 38138
Phone (901) 261-0700
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IBHBDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APN0000024154 | TN | Yes |
| Family Nurse Practitioner | 363LF0000X | 902387 | MS |
Addresses
Primary practice location
526 Halle Park Dr
Collierville, TN 38017-7085
Mailing address
8418 Regal Bend Dr
Olive Branch, MS 38654-4415
Phone (662) 512-2237
Other practice location 1
491 W Poplar Ave
Collierville, TN 38017-2537
Phone (901) 861-0001
Other providers in Collierville, TN
- Dental Implant Aesthetic Center
- Dwana Jeane Desanctis
- Jill Suzanne Detty Oswaks
- Matthew Zane Devazier
- Phyllis A Dickinson-Branch
- Nicholas Alexander Diloreto
- Jeffrey A Dlabach
- Nicole D Dotson
- Mia Star Douglas
- Dr Mark Lynn & Associates PLLC
All providers in Collierville, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.