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KENT RYAN HARDEE DICKERSON MD
NPI 1740084631
Student in an Organized Health Care Education/Training Program in Winston Salem, NC

Active since April 02, 2025PECOS Enrolled
5TH JANEWAY TOWER 1 MEDICAL, WINSTON SALEM, NC 27157(336) 716-0423 Get Directions Write a Review

NPPES record last updated: April 2, 2025. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Kent Ryan Hardee Dickerson Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENT RYAN HARDEE DICKERSON MD (NPI 1740084631) is an individual student in an organized health care education/training program in Winston Salem, North Carolina and active in the NPI registry since April 2025. He is enrolled in Medicare PECOS and maintains a secondary practice location in Williamston.

NPPES Registry Identity

NPI1740084631
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameKENT RYAN HARDEE DICKERSONCredential: MD
Location Address5TH JANEWAY TOWER 1 MEDICALWinston Salem, NC 27157-0001
Mailing AddressOne Medical Center Blvd Nc 27157.Winston Salem, NC 27157-0001 · (252) 217-9730
Phone(336) 716-0423
Sole ProprietorYes
Enumeration DateApril 2, 2025
NPPES CertifiedMarch 24, 2025
✔ NPI 1740084631 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
5TH JANEWAY TOWER 1 MEDICAL, Winston Salem, NC 27157
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Secondary Practice Location 1

Location 11170 Hardison RdWilliamston, NC 27892-9124 · Phone (252) 217-9730

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kent Ryan Hardee Dickerson Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kent Dickerson's NPI number?

The NPI number for Kent Dickerson is 1740084631. It was assigned to this individual provider in the NPPES registry on April 2, 2025.

Where is Kent Dickerson located?

Kent Dickerson practices at 5th Janeway Tower 1 Medical, Winston Salem, NC 27157. The listed phone number is (336) 716-0423.

What is Kent Dickerson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Kent Dickerson enrolled in Medicare?

Yes. Kent Dickerson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kent Dickerson was last updated on April 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.