Provider Demographics
NPI:1568545887
Name:WYKLE, DELL E (BS)
Entity Type:Individual
Prefix:MRS
First Name:DELL
Middle Name:E
Last Name:WYKLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:DELL
Other - Middle Name:E
Other - Last Name:SUSONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:616 E CHURCH ST
Practice Address - Street 2:FRONTIER HEALTH
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743
Practice Address - Country:US
Practice Address - Phone:423-639-3213
Practice Address - Fax:423-639-4692
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator