Provider Demographics
NPI:1689461667
Name:DYKE, KARISSA PAIGE
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:PAIGE
Last Name:DYKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 RIVERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-3155
Mailing Address - Country:US
Mailing Address - Phone:270-252-4286
Mailing Address - Fax:
Practice Address - Street 1:109 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1123
Practice Address - Country:US
Practice Address - Phone:270-527-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program