Provider Demographics
NPI:1912035247
Name:LYKINS, CHARLES E
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:LYKINS
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:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-0355
Mailing Address - Country:US
Mailing Address - Phone:740-250-3232
Mailing Address - Fax:
Practice Address - Street 1:102 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8742
Practice Address - Country:US
Practice Address - Phone:740-250-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2491398Medicaid