Provider Demographics
NPI:1114175973
Name:CUMMINGS, JESTYN M (ARNP)
Entity Type:Individual
Prefix:
First Name:JESTYN
Middle Name:M
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3302
Mailing Address - Country:US
Mailing Address - Phone:253-680-6018
Mailing Address - Fax:
Practice Address - Street 1:1501 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3302
Practice Address - Country:US
Practice Address - Phone:253-680-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60044793363L00000X
WARN00168049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0291783OtherSTATE L&I
WA0255762OtherSTATE L&I
WA0246357OtherSTATE L&I
WAG8907962Medicare PIN
WA0246357OtherSTATE L&I
WAG8887524Medicare PIN