Provider Demographics
NPI:1619485661
Name:PYKE, JEREMY ABRAHAM (APN)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ABRAHAM
Last Name:PYKE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6297 SECTION AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-9059
Mailing Address - Country:US
Mailing Address - Phone:732-595-6384
Mailing Address - Fax:
Practice Address - Street 1:1810 BROADWAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3133
Practice Address - Country:US
Practice Address - Phone:360-738-7654
Practice Address - Fax:360-738-8155
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00784300363LF0000X
WAAP61009702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily