Provider Demographics
NPI:1194000489
Name:DYKES, LAUREN MATHEWS (NP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MATHEWS
Last Name:DYKES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 3RD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3294
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-742-2040
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3294
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:478-742-2040
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily