Provider Demographics
NPI:1366549354
Name:DYKES, RYAN SLADE SR (FNP)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:SLADE
Last Name:DYKES
Suffix:SR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 LEVEE RD.
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366
Mailing Address - Country:US
Mailing Address - Phone:318-766-1967
Mailing Address - Fax:
Practice Address - Street 1:1115 LEVEE RD.
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:LA
Practice Address - Zip Code:71366
Practice Address - Country:US
Practice Address - Phone:318-766-1967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 05009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily