MRS. MADELINE MCCLUER DICKERSON (NPI# 1104220029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104220029 |
| Entity Type | Individual |
| Full Name | MRS. MADELINE MCCLUER DICKERSON |
| Credential | AG-ACNP |
| Practice Address |
1521 Cooper St Fort Worth TX 76104-2711 |
| Mailing Address |
601 Omega Dr Suite 206 Arlington TX 76014-2075 |
| Practice Telephone | 8173365864 |
| Practice Fax Number | 8173362159 |
| Mailing Telephone | 8174655881 |
| Mailing Fax Number | 8174656336 |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2015-02-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
AP126665 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1521 COOPER ST |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-2711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881688331 | Kerim F Razack | Internal Medicine | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2005-09-09 |
| 1134599863 | Kailee Marie Hughes | Nurse Practitioner | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2015-10-07 |
| 1134528169 | Donald Edward Watenpaugh | Sleep Specialist, PhD | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2014-08-14 |
| 1265862197 | Margaret Adelia Davis | Nurse Practitioner | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2013-11-13 |
| 1629407077 | May Ha Goetsch | Nurse Practitioner | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2013-11-06 |
| 1487942280 | Carina Manalo | Nurse Practitioner | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2011-07-13 |
| 1275853327 | Vikas Goyal | Internal Medicine | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2010-06-10 |
| 1598082679 | Amy Michelle Bird | Nurse Practitioner | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2010-04-28 |
| 1649594268 | Steven Kim | Internal Medicine | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2010-03-25 |
| 1598944050 | Jodi P English | Clinical Nurse Specialist | 1521 Cooper St, Fort Worth, TX 76104-2711 | 2007-10-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184223786 | Vincy Saji Mathew | Nurse Practitioner | 8804 Viridian Ln, Fort Worth, TX 76123-4030 | 2020-10-23 |
| 1821635814 | Sarah Elizabeth Martin | Nurse Practitioner | 4212 Selkirk Dr W, Fort Worth, TX 76109-5328 | 2019-12-09 |
| 1568930360 | Chelsea Lynne Outhier | Nurse Practitioner | 4628 Belladonna Dr, Fort Worth, TX 76123-1841 | 2018-11-09 |
| 1265900567 | Sarah Jane Armendarez | Nurse Practitioner | 6715 Bluffview Dr, Fort Worth, TX 76132-3062 | 2018-11-05 |
| 1548736366 | Nina Quijano | Nurse Practitioner | 8209 Whistling Duck Dr, Fort Worth, TX 76118-7623 | 2018-10-18 |
| 1275015612 | Falguni Udayan Patel | Nurse Practitioner | 6100 Harris Pkwy Ste 1230, Fort Worth, TX 76132 | 2018-09-02 |
| 1487159612 | Jose Sanchez | Nurse Practitioner | 3540 Wharton Dr, Fort Worth, TX 76133-2121 | 2018-03-29 |
| 1376057752 | Shabnum Shakeel Zaman | Nurse Practitioner | 816 Stone Water Dr Apt 1015, Fort Worth, TX 76120-2798 | 2017-11-21 |
| 1376081752 | Cheryl D. Mitchell | Nurse Practitioner | 11803 S. Freeway, Ste. 311, Fort Worth, TX 76115 | 2017-02-06 |
| 1184167561 | Reynaldo Daba II | Nurse Practitioner | 1412 May St, Fort Worth, TX 76104-7639 | 2016-12-02 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
Please comment or provide details below to improve the information on MRS. MADELINE MCCLUER DICKERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.