Provider Demographics
NPI:1477107753
Name:DYKES-COOPER, CHRISTIE NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:NICHOLE
Last Name:DYKES-COOPER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47408 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-7233
Mailing Address - Country:US
Mailing Address - Phone:985-351-1479
Mailing Address - Fax:
Practice Address - Street 1:615 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6510
Practice Address - Country:US
Practice Address - Phone:225-400-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty