Provider Demographics
NPI:1942315627
Name:SYKES, RICHARD DEAN (APRN, BC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:SYKES
Suffix:
Gender:M
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 SHELBY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7316
Mailing Address - Country:US
Mailing Address - Phone:901-252-7600
Mailing Address - Fax:901-252-7680
Practice Address - Street 1:993 CORDOVA STATION AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6317
Practice Address - Country:US
Practice Address - Phone:901-737-4565
Practice Address - Fax:901-737-4312
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5883363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928030Medicaid
TN3376331Medicaid
TN4088131OtherBCBS
Q08159Medicare UPIN
TN3376331Medicaid
3370154Medicare PIN
TN3928030Medicare ID - Type UnspecifiedINDIVIDUAL #