MEDICARE: MRS. KIMBERLY MILLER DYKES ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9204166	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y04LT	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629391883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MILLER DYKES ARNP-C

Provider Business Mailing Address
First Line	:	4215 KELSON AVE STE D
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446-6555
Country	:	US
Telephone Number	:	850-317-6378
Fax Number	:	850-308-2153

Provider Business Practice Location Address
First Line	:	4215 KELSON AVE STE D
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446-6555
Country	:	US
Telephone Number	:	850-317-6378
Fax Number	:	850-308-2153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/10/2022

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Directions to “ MRS. KIMBERLY MILLER DYKES ARNP-C” Practice Location

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