Provider Demographics
NPI:1518649771
Name:BAKKER, GAVIN A (ARNP)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:A
Last Name:BAKKER
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 1:214 N 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2703
Mailing Address - Country:US
Mailing Address - Phone:509-961-1850
Mailing Address - Fax:
Practice Address - Street 1:3810 KERN WAY STE D
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7805
Practice Address - Country:US
Practice Address - Phone:509-248-4303
Practice Address - Fax:509-469-2441
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60835963163WE0003X
WAAP61491164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency