Andrew Dickerson

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

133485 Issued in MO

Practice address

5637 Walnut Point LN
Saint Charles, MO 63304-4539

Phone

(636) 300-3017

NPI assigned

Jan 4, 2017

Last updated

Jan 4, 2017By 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

Other identifiers 1

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": "1483488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483488000000",
    "number": "1528503364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5637 WALNUT POINT LN",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633044539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5637 WALNUT POINT LN",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633044539",
            "telephone_number": "636-300-3017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "ANDREW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-04",
        "last_updated": "2017-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "133485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phillip Richard Devore, PHARM.D.
• Katherine M Dewey, M.D.
• Dhi Inc. (St. Charles Rexall Drug Co.)
• Joseph Anthony Di Carlo, D.C.
• Dicarlo Chiropractic Center P C
• Dicus Chiropractic Clinic, P.C.
• Donald Wayne Dicus, D.C.
• Elizabeth Diebold, LMT
• Kathleen Diemer
• Jillian Diepenbrock, PHARM.D.

• Registered Nurse in Saint Charles, MO
• Providers in Saint Charles, MO by specialty
• Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.