Dickerson Isl

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

9227 Issued in MO

Legal business name

DICKERSON ISL

Practice address

9401 E 90TH Ter
Kansas City, MO 64138-4770

Phone

(816) 353-8850

NPI assigned

Apr 14, 2008

Last updated

Apr 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles Ray Dickerson

Title

Provider

Phone

(816) 353-8850

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208131200000",
    "number": "1255505939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9401 E 90TH TER",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641384770",
            "telephone_number": "816-353-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 E 90TH TER",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641384770",
            "telephone_number": "816-353-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKERSON ISL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "816-353-8850",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "9227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanisha Anner Diaz, FNP-BC
• Diedre A Dibal, APRN CNM
• Joseph Dibenedetto
• Michael Julius Dibernardo, MD
• John Michael Dicapo, DPT, ATC
• Diana Lynn Dickey, PT
• Douglas James Dickey, M.D.
• Alexandra Kay Dickinson, RN
• Kendrea Dickinson
• Lois Jean Dickinson, ANP

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.