Provider Demographics
NPI:1487054029
Name:DYKES, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DYKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 WASHBURN AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7000
Mailing Address - Country:US
Mailing Address - Phone:704-713-2318
Mailing Address - Fax:980-585-2855
Practice Address - Street 1:1830 ETHEL GUEST LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2912
Practice Address - Country:US
Practice Address - Phone:704-713-2318
Practice Address - Fax:704-910-3995
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications