Michael Ray Dickerson, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

53-82295-122 Issued in KS

Practice address

8016 State Line Rd Ste 205
Prairie Village, KS 66208-3713

Phone

(913) 251-9207

Fax

(913) 243-2007

NPI assigned

Jun 9, 2023

Last updated

Jan 28, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738022400000",
    "number": "1447934526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8016 STATE LINE RD STE 205",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662083713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8016 STATE LINE RD STE 205",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662083713",
            "telephone_number": "913-251-9207",
            "fax_number": "913-243-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "MICHAEL",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-09",
        "last_updated": "2025-01-28",
        "certification_date": "2025-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-82295-122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dustin Degraffenreid
• Dirck Louis Dekeyser, O.D.
• Savannah Demeyer
• Cindi Jo Devilbiss, L.S.C.S.W.
• William Stuart Dexter, D.D.S.
• Theodore Constantine Dimas, D.D.S.
• Jennifer Dioszeghy, M.D.
• Tiffonie Kai Dirks, M.P.T.
• Abigail Marie Doerksen, MS
• Alan Charles Domian, PH.D.

• Family Nurse Practitioner in Prairie Village, KS
• Providers in Prairie Village, KS by specialty
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2025; 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.