Provider Demographics
NPI:1295172542
Name:DYKES, NICOLE D
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:D
Last Name:DYKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 ESSARY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2409
Mailing Address - Country:US
Mailing Address - Phone:865-687-8990
Mailing Address - Fax:
Practice Address - Street 1:6635 RUBY JUNE LN
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3964
Practice Address - Country:US
Practice Address - Phone:865-386-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health