Heather Elizabeth Dickerson

Key facts

NPI: 1730948860
Entity type: Individual (NPI type 1)
Primary specialty: Day Training/Habilitation Specialist 373H00000X
Practice address: 2740 College Ave
Conway, AR 72034-6141
Phone: (501) 329-5459
NPI assigned: Mar 19, 2024
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Kid Success, Inc. Rehabilitation Clinic/Center · Conway, AR · NPI 1609997311

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Kid Success, Inc.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Day Training/Habilitation Specialist	373H00000X		AR	Yes

Addresses

Primary practice location

2740 College Ave
Conway, AR 72034-6141

Mailing address

2740 College Ave
Conway, AR 72034-6141
Phone (501) 329-5459

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 19, 2024.

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1730948860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346141",
            "telephone_number": "501-329-5459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 COLLEGE AVE",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346141",
            "telephone_number": "501-329-5459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "HEATHER",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

All providers in Conway, AR · Day Training/Habilitation Specialist in Arkansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.