Healthcare Provider Details

I. General information

NPI: 1386917763
Provider Name (Legal Business Name): CECILY ELLEN LYKES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE STE 507
CHEYENNE WY
82001-3179
US

IV. Provider business mailing address

PO BOX 20970
CHEYENNE WY
82003-7020
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-2562
  • Fax: 307-638-2074
Mailing address:
  • Phone: 307-635-2562
  • Fax: 307-638-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number39353
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20193A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: