Healthcare Provider Details

I. General information

NPI: 1902447477
Provider Name (Legal Business Name): AMANDA KAY DYKES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KAY DYKES AMANDA KAY STERKEL

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 5TH ST
DOUGLAS WY
82633
US

IV. Provider business mailing address

623 HARRISON ST
DOUGLAS WY
82633-2739
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-7300
  • Fax:
Mailing address:
  • Phone: 307-338-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44725
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: