Provider Demographics
NPI:1508358201
Name:PIKE, ADAM J (ARNP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:PIKE
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 1:2075 NE WYATT CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7686
Mailing Address - Country:US
Mailing Address - Phone:541-382-5882
Mailing Address - Fax:541-633-1590
Practice Address - Street 1:2075 NE WYATT CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7686
Practice Address - Country:US
Practice Address - Phone:541-382-5882
Practice Address - Fax:541-633-1590
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0000000363LF0000X
OR201905020NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily