| Doctor Name: | KARISSA DICKEN |
| NPI Number: | 1043631732 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R178129 |
| Business Practice Address: | 510 Butler Ave Martinsburg, WV - 254059990 |
| Business Phone Number: | 3017240061 |
| Business Fax Number: | |
| Mailing Address: | 510 Butler Ave, MARTINSBURG |
| State: | WV |
| Postal Code: | 254059990 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/23/2013 |
| NPI Last Update Date: | 12/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R178129 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |