Healthcare Provider Details

I. General information

NPI: 1831810647
Provider Name (Legal Business Name): JOSHUA JOSEPH LYKOWSKI AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 632500
CINCINNATI OH
45263-2500
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2450
  • Fax: 843-724-2455
Mailing address:
  • Phone: 888-472-0043
  • Fax: 513-653-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number4704272693
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0039522
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number32042
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: