Healthcare Provider Details

I. General information

NPI: 1376742932
Provider Name (Legal Business Name): WENDY E. LYKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S KY 7
SANDY HOOK KY
41171-6830
US

IV. Provider business mailing address

390 S KY 7
SANDY HOOK KY
41171-6830
US

V. Phone/Fax

Practice location:
  • Phone: 606-738-5155
  • Fax: 606-738-5420
Mailing address:
  • Phone: 606-738-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005235
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005235
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: