Dickenson, Russell Eric

Dickenson, Russell Eric is an individual health care provider with primary practice located at 10800 Parkside Dr Ste 331 , Knoxville TN 37934-1922. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Dickenson, Russell Eric can be contacted via phone (865) 392-3400.

Contact Information

Primary practice address
10800 Parkside Dr Ste 331 Knoxville TN 37934-1922
Phone: (865) 392-3400
Fax: (865) 392-3449
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 100 Tennessee

Profile Details

NPI number 1497745814
LBN Legal business name Dickenson, Russell Eric
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2005
Last updated Sep 14th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497745814 NPPES
Tennessee MEDICAID 3665210

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