Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11499 | TX |
N | 111NI0013X | Independent Medical Examiner | 11499 | TX |
N | 111NN1001X | Nutrition | 11499 | TX |
NPI | 1710289491 |
---|---|
Provider Name | Dr. Katerina Sheffield Dickey |
First Address | Lago Vista, TX 78645 |
Second Address | Austin, TX 78746-4945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2010 |
Last Update Date | 01/05/2012 |