Provider Demographics
NPI:1174529598
Name:DICKENS, ELIZABETH L (CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:DICKENS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:L
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2980 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4845
Mailing Address - Country:US
Mailing Address - Phone:972-899-9787
Mailing Address - Fax:972-899-9786
Practice Address - Street 1:2980 LONG PRAIRIE RD
Practice Address - Street 2:SUITE E
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4845
Practice Address - Country:US
Practice Address - Phone:972-899-9787
Practice Address - Fax:972-899-9786
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536369367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
8Y8646OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX141996203Medicaid
TX141996203Medicaid
8Y8646OtherBLUE CROSS BLUE SHIELD OF TEXAS