Laura Renee Dickerson, DNP, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.026248 Issued in IL

Practice address

404 W Blackhawk Dr Lowr Level
Byron, IL 61010-7500

Phone

(815) 904-1249

NPI assigned

Nov 1, 2022

Last updated

Dec 27, 2023By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Integrative Medical Associates of Rockford, LLC

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1164845459
  NPD (past)

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

{
    "created_epoch": "1667260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1710694401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W BLACKHAWK DR LOWR LEVEL",
            "city": "BYRON",
            "state": "IL",
            "postal_code": "610107500",
            "telephone_number": "815-904-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W BLACKHAWK DR LOWR LEVEL",
            "city": "BYRON",
            "state": "IL",
            "postal_code": "610107500",
            "telephone_number": "815-904-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "LAURA",
        "middle_name": "RENEE",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-01",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "041.428105",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.026248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Eleanor Bridges
• Wendy Bulthuis-Susong
• Jeremy Buttram, PTA
• Byron Cusd 226
• Byron Fire Protection District
• Jenifer Elizabeth Druien, PT
• Eats and Speaks
• Grace Elaine Edwards
• Eyecare Dimensions LLC (EyeCare Dimensions)
• Felker Pharmacy Inc (Byron Snyders Pharmacy)

• Family Nurse Practitioner in Byron, IL
• Providers in Byron, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; 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.