Provider Demographics
NPI:1902136302
Name:DYKES, ANNY GUTHRIE (PAC)
Entity Type:Individual
Prefix:
First Name:ANNY
Middle Name:GUTHRIE
Last Name:DYKES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55845
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5845
Mailing Address - Country:US
Mailing Address - Phone:205-279-2860
Mailing Address - Fax:205-252-0197
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-279-2860
Practice Address - Fax:205-252-0197
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant