Provider Demographics
NPI:1487190252
Name:WYKOFF, JAIDEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAIDEN
Middle Name:
Last Name:WYKOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIDEN
Other - Middle Name:
Other - Last Name:HUMBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:RAF LAKENHEATH 48 MDG
Mailing Address - Street 2:UNIT 5210 BOX 230
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-0230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 MDG/SGHC
Practice Address - Street 2:UNIT 5115
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461-5115
Practice Address - Country:US
Practice Address - Phone:0163852-226-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant