Provider Demographics
NPI:1518167832
Name:DYESS, RENEE OKJA (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:OKJA
Last Name:DYESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 OLD HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8568
Mailing Address - Country:US
Mailing Address - Phone:601-954-5565
Mailing Address - Fax:
Practice Address - Street 1:151 E METRO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-4402
Practice Address - Country:US
Practice Address - Phone:601-992-3288
Practice Address - Fax:601-992-3188
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04139568Medicaid
753068151OtherUHC
9532175OtherAETNA
$$$$$$$$$OtherBCBS
753068151OtherMHP
MS04139568Medicaid
168390709OtherUS DEPT OF LABOR
753068151OtherMPCN
$$$$$$$$$OtherBCBS