Elaine Burgess Dickson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA200138 Issued in LA

Practice address

1500 Line Ave
Ste 100
Shreveport, LA 71101

Phone

(318) 635-3052

Fax

(318) 632-6087

NPI assigned

Oct 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Elaine C Burgess Former name

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": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417996800000",
    "number": "1407044001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534 ELIZABETH AVE",
            "address_2": "SUITE 201",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014516",
            "telephone_number": "318-629-5002",
            "fax_number": "318-629-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LINE AVE",
            "address_2": "STE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-635-3052",
            "fax_number": "318-632-6087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "ELAINE",
        "middle_name": "BURGESS",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2014-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA200138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELAINE",
            "last_name": "BURGESS",
            "middle_name": "C",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cassandra Dickerson
• Latosha Dickerson
• Ramee Dickerson
• Amy Kristen-Lee Dickey
• Julie Sippel Dickinson, MCD, CCC-SLP
• Laura Janet Dickson
• Naomi Diego- Gaspar
• Alexander Dien, DPT
• Gregor Jackson Dierks
• David F Dies, M.D

• Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.