Provider Demographics
NPI:1861040206
Name:DYKES, AUSTIN MOORE
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:MOORE
Last Name:DYKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 E SOUTHERN AVE APT 242
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2630
Mailing Address - Country:US
Mailing Address - Phone:229-344-8953
Mailing Address - Fax:
Practice Address - Street 1:511 SMOKY PARK HWY
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8613
Practice Address - Country:US
Practice Address - Phone:828-365-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61226812363A00000X
NC0010-13522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant