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General NPI Number Information
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NPI Number | 1861296808
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Entity Type | Individual
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Provider Name | WILLIAM BRYANT DYCUS
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Gender | Male
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 1120 SAMS ST
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City | COOKEVILLE
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State | TN
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Zip | 38506-4006
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Country | US
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Telephone | 931-528-7312
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Fax | 931-528-7377
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Provider Business Mailing Address
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Address Line | 4255 BUFFALO VALLEY RD
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City | COOKEVILLE
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State | TN
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Zip | 38501-6633
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Country | US
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Telephone | 931-349-5635
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 38513
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN38513
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License Number State | TN
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