Healthcare Provider Details

I. General information

NPI: 1487510863
Provider Name (Legal Business Name): MIKAYLA MAE DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E MAIN ST
LINCOLNTON NC
28092-3449
US

IV. Provider business mailing address

PO BOX 749
BELMONT NC
28012-0749
US

V. Phone/Fax

Practice location:
  • Phone: 704-748-0616
  • Fax: 704-240-9980
Mailing address:
  • Phone: 704-869-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number3964
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: