Jeffry Alan Dickerson, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP118266 Issued in TX

Practice address

3903 Wiseman Blvd, Ste 311
San Antonio, TX 78251-4422

Phone

(210) 615-1901

Fax

(210) 615-1905

NPI assigned

Jan 13, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spcsa PLLC

  • Pain Medicine (Anesthesiology) Physician
  • San Antonio, TX
  • NPI 1720008527
  Medicare reassignment

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1699070144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 117614",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750114422",
            "telephone_number": "210-615-1901",
            "fax_number": "210-615-1905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 WISEMAN BLVD, STE 311",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514422",
            "telephone_number": "210-615-1901",
            "fax_number": "210-615-1905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12602 Toepperwein Rd Ste 218",
            "address_purpose": "LOCATION",
            "city": "Live Oak",
            "state": "TX",
            "postal_code": "782333271",
            "country_code": "US",
            "telephone_number": "210-615-1901",
            "fax_number": "210-615-1905",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3603 Paesanos Pkwy, Ste 205A",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782311227",
            "country_code": "US",
            "telephone_number": "210-615-1901",
            "fax_number": "210-615-1905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "JEFFRY",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-13",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP118266",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP118266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keenan Ross Dickens, DO
• Kelly Dickens, OT
• Gabriela Dicker
• Alyssa Renee Dickerson
• Cassandra L Dickerson
• Jeremy Lee Dickerson, MD
• Jill Theresa Dickerson, CNS-MS
• Rhonda Ellen Dickey, LVN
• Trevor Alexander Dickey, MD
• Samantha Morgan Dickie

• Nurse Practitioner in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.