Healthcare Provider Details

I. General information

NPI: 1497546725
Provider Name (Legal Business Name): EMILY DYKEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL DR
GALAX VA
24333-2227
US

IV. Provider business mailing address

91 OLD TAVERN CIR
LYNCHBURG VA
24501-7753
US

V. Phone/Fax

Practice location:
  • Phone: 127-623-6818
  • Fax:
Mailing address:
  • Phone: 757-316-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: