Healthcare Provider Details

I. General information

NPI: 1619386968
Provider Name (Legal Business Name): CATHERINE NICOLE LYKINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE N BUDDE

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 250
CUMMING GA
30041-7701
US

IV. Provider business mailing address

1400 NORTHSIDE FORSYTH DR STE 250
CUMMING GA
30041-7701
US

V. Phone/Fax

Practice location:
  • Phone: 770-889-7118
  • Fax: 770-844-7835
Mailing address:
  • Phone: 770-889-7118
  • Fax: 770-844-7835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206894
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: