Provider Demographics
NPI:1003191503
Name:SYKES, LARRY JUSTAIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JUSTAIN
Last Name:SYKES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3021
Mailing Address - Country:US
Mailing Address - Phone:336-228-9671
Mailing Address - Fax:336-228-9674
Practice Address - Street 1:217 E ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3021
Practice Address - Country:US
Practice Address - Phone:336-228-9671
Practice Address - Fax:336-228-9674
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC3575BMedicare PIN