Active NPI
Tanya Danette Dickerson, RN
- Registered Nurse
- Iva, SC
National Provider Identifier
1487091724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 89617
- Practice address
- 9104 Hwy 81 South
Iva, SC 29655 - Phone
- (864) 352-6175
- Fax
- (864) 352-2308
- NPI assigned
- May 28, 2013
- Last updated
- May 28, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 89617 | SC | Primary |
Addresses
Primary practice location
9104 Hwy 81 South
Iva, SC 29655
Mailing address
P.O. Box 118
Iva, SC 29655
Phone (864) 348-6196
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89617 | SC | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369699200000",
"number": "1487091724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 118",
"city": "IVA",
"state": "SC",
"postal_code": "29655",
"telephone_number": "864-348-6196",
"fax_number": "864-348-6198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9104 HWY 81 SOUTH",
"city": "IVA",
"state": "SC",
"postal_code": "29655",
"telephone_number": "864-352-6175",
"fax_number": "864-352-2308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "TANYA",
"middle_name": "DANETTE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-05-28",
"last_updated": "2013-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "SC",
"license": "89617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iva, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.