Healthcare Provider Details

I. General information

NPI: 1346760071
Provider Name (Legal Business Name): ALYSSA HOPE DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N COLLEGE AVE
EL DORADO AR
71730-4403
US

IV. Provider business mailing address

715 N COLLEGE AVE
EL DORADO AR
71730-4403
US

V. Phone/Fax

Practice location:
  • Phone: 870-862-7921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8363C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: