NPI 1013659960
Jacob Edward Dickerson, DNAP
Practice location
- Address
- 100 S Bliss Ave, Tahlequah, OK 74464-2512
- Phone
- (918) 458-3100
- Mailing address
- 21781 E 785 Rd, Welling, OK 74471-2035
Registered specialties (2)
Certified Registered Nurse Anesthetist
Primary
Student in an Organized Health Care Education/Training Program
Registry record
- NPI
- 1013659960
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 11 Apr 2022
- Record last updated
- 10 Jul 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.