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General NPI Number Information
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NPI Number | 1114287109
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Entity Type | Individual
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Provider Name | MR. DAVID PAYNE DYKES
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Gender | Male
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 235 S TREATING PLANT RD
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City | DE QUEEN
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State | AR
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Zip | 71832-2909
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Country | US
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Telephone | 870-642-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MARCONE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-4030
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Country | US
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Telephone | 870-784-3756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 00-0075
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License Number State | AR
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