Provider Demographics
NPI:1093158412
Name:WHEELER, JACYNDA LOUISE (DO)
Entity Type:Individual
Prefix:DR
First Name:JACYNDA
Middle Name:LOUISE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JACYNDA
Other - Middle Name:
Other - Last Name:WNEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2562
Mailing Address - Country:US
Mailing Address - Phone:360-299-4297
Mailing Address - Fax:360-299-4294
Practice Address - Street 1:2511 M AVE STE G
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3897
Practice Address - Country:US
Practice Address - Phone:360-299-4297
Practice Address - Fax:360-299-4294
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP605856232084P0800X
NMR04-2013390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program