Provider Demographics
NPI:1891305595
Name:DYKES, NICHOLLETTE VICTORIA (NP)
Entity type:Individual
Prefix:
First Name:NICHOLLETTE
Middle Name:VICTORIA
Last Name:DYKES
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 16TH ST STE 1460
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5202
Mailing Address - Country:US
Mailing Address - Phone:303-529-6467
Mailing Address - Fax:303-622-1128
Practice Address - Street 1:110 16TH ST STE 1460
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5202
Practice Address - Country:US
Practice Address - Phone:303-529-6467
Practice Address - Fax:303-622-1128
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002324363LP0808X
CO00001078363LP0808X
TX1006402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health