Individual ProviderEmmanuell DickersonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address449 W 23rd St, Panama City, FL 32405(334) 618-2614PECOS EnrollmentBased on the most recent information from CMS, provider Emmanuell Dickerson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1336528173Provider TypeIndividualFull NameDickerson, EmmanuellTitleMrs.CredentialAPRNGenderFemaleSole ProprietorYesEnumeration Date5/26/2015Last Updated12/6/2022Contact InformationPractice LocationPractice Address449 W 23rd St, Panama City, FL 32405Phone(334) 618-2614Fax(334) 618-2614Mailing LocationMailing Address110 James Way, Panama City, FL 32409-1776Phone(334) 618-2614Fax(334) 618-2614Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseARNP 9409105FloridaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicenseRN9409105FloridaCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense3-001041Alabama