Healthcare Provider Details

I. General information

NPI: 1114287109
Provider Name (Legal Business Name): MR. DAVID PAYNE DYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S TREATING PLANT RD
DE QUEEN AR
71832-2909
US

IV. Provider business mailing address

111 MARCONE DR
DE QUEEN AR
71832-4030
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-3100
  • Fax:
Mailing address:
  • Phone: 870-784-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number00-0075
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: