Provider Demographics
NPI:1891305595
Name:DYKES, NICHOLLETTE VICTORIA (NP)
Entity Type:Individual
Prefix:
First Name:NICHOLLETTE
Middle Name:VICTORIA
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 1:8089 S LINCOLN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2720
Mailing Address - Country:US
Mailing Address - Phone:832-741-3414
Mailing Address - Fax:
Practice Address - Street 1:8089 S LINCOLN ST STE 207
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2720
Practice Address - Country:US
Practice Address - Phone:832-741-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00001078363LP0808X
CO00002324363LP0808X
TX1006402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health