Kenneth Willie Dickerson SR.

NPI #1043744790 in Houston, Texas

Provider Information

NPI Number: 1043744790
Entity Type: Individual
Name: Kenneth Willie Dickerson SR.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Driver
Enumeration Date: Apr 19, 2017
Last Updated: Apr 19, 2017

Practice Location

Address: 15530 ELLA BLVD APT 719
City: Houston
State: Texas
ZIP Code: 77090
Phone: (832) 892-1079

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Driver	172A00000X	Primary
Prevention Professional	405300000X

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