Marc T Dicker, PAC, LCPC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-15-00156 Issued in KS

Practice address

7829 E Rockhill St
Suite 101
Wichita, KS 67206-3920

Phone

(316) 686-5195

Fax

(316) 686-8714

NPI assigned

Sep 1, 2006

Last updated

Dec 22, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292976000000",
    "number": "1366544553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7829 E ROCKHILL ST",
            "address_2": "SUITE 101",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063920",
            "telephone_number": "316-686-5195",
            "fax_number": "316-686-8714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7829 E ROCKHILL ST",
            "address_2": "SUITE 101",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063920",
            "telephone_number": "316-686-5195",
            "fax_number": "316-686-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKER",
        "first_name": "MARC",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "PAC, LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2010-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "PA-15-00156",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KS",
            "license": "PA-15-00156",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KS",
            "license": "LCPC-127",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100352880A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adriana Diaz
• Derick E Diaz
• Derick Tariq Diaz
• Allison Nicole Dick, APRN
• Charles Tyler Dick, CRNA
• John R Dickerson, M.D.
• Kristine Karban Dickinson, MS,OTR/L
• Kalie Dickman
• Laura Dickson, APRN
• Jeanette Diederich, LSCSW

• Physician Assistant in Wichita, KS
• Providers in Wichita, KS by specialty
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; 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.