Healthcare Provider Details

I. General information

NPI: 1235013871
Provider Name (Legal Business Name): OCEANNA DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 COLLEGE HEIGHTS BLVD
BOWLING GREEN KY
42101-1000
US

IV. Provider business mailing address

872 LYNNWOOD WAY APT 512
BOWLING GREEN KY
42104-3028
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-4204
  • Fax:
Mailing address:
  • Phone: 270-993-5416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: