Provider Demographics
NPI:1629831441
Name:LYKENS, KACEY A (RT(R))
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:A
Last Name:LYKENS
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26035 STATE HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:AL
Mailing Address - Zip Code:35172-8748
Mailing Address - Country:US
Mailing Address - Phone:205-492-6794
Mailing Address - Fax:
Practice Address - Street 1:26035 STATE HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:TRAFFORD
Practice Address - State:AL
Practice Address - Zip Code:35172-8748
Practice Address - Country:US
Practice Address - Phone:205-492-6794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography