Healthcare Provider Details

I. General information

NPI: 1861180689
Provider Name (Legal Business Name): KAMI D. DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

6784 HIGHWAY 411
BENTON TN
37307-4818
US

V. Phone/Fax

Practice location:
  • Phone: 844-863-3236
  • Fax:
Mailing address:
  • Phone: 423-338-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33048
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000033048
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: