Healthcare Provider Details

I. General information

NPI: 1417396904
Provider Name (Legal Business Name): ANGELA E DYKES DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 12/18/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 EDGEFIELD RD STE 170
NORTH AUGUSTA SC
29841-6407
US

IV. Provider business mailing address

528 JOHN FOXS RUN
NORTH AUGUSTA SC
29860-7524
US

V. Phone/Fax

Practice location:
  • Phone: 803-282-9481
  • Fax: 803-645-7611
Mailing address:
  • Phone: 225-284-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN121215
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN228108
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSC19037
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: