NPI 1043744790

Kenneth Willie Dickerson

Practitioner Driver Houston, TX

Practice location

Address: 15530 Ella Blvd APT 719, Houston, TX 77090
Phone: (832) 892-1079
Mailing address: 15530 Ella Blvd APT 719, Houston, TX 77090-5310

Registered specialties (2)

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 24512126 (TX)

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Prevention Professional

Other Service Providers Taxonomy 405300000X Licence 24512126 (TX)

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Registry record

NPI: 1043744790
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Apr 2017
Record last updated: 19 Apr 2017

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.