Healthcare Provider Details

I. General information

NPI: 1487054029
Provider Name (Legal Business Name): PATRICIA DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 ETHEL GUEST LN
CHARLOTTE NC
28206-2912
US

IV. Provider business mailing address

3325 WASHBURN AVE STE 111
CHARLOTTE NC
28205-7000
US

V. Phone/Fax

Practice location:
  • Phone: 704-713-2318
  • Fax: 704-910-3995
Mailing address:
  • Phone: 704-713-2318
  • Fax: 980-585-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: