Provider Demographics
NPI:1518913060
Name:DYKES, PATRICIA PEARCE (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:PEARCE
Last Name:DYKES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CAMP EIGHT RD
Mailing Address - Street 2:
Mailing Address - City:RICHTON
Mailing Address - State:MS
Mailing Address - Zip Code:39476-8907
Mailing Address - Country:US
Mailing Address - Phone:601-788-5725
Mailing Address - Fax:601-788-6335
Practice Address - Street 1:210 BAY AVE.L
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476
Practice Address - Country:US
Practice Address - Phone:601-788-9222
Practice Address - Fax:601-788-6335
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR623555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0017191Medicaid
MSR623555OtherLICENSE NUMBER
MS0017191Medicaid
MS500002152Medicare PIN