Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 205064 | LA |
NPI | 1033779087 |
---|---|
Provider Name | Drew L. Dykes |
First Address | Baton Rouge, LA 70806-5922 |
Second Address | Baton Rouge, LA 70806-5922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 20/06/2019 |