Provider Demographics
NPI:1245833425
Name:MIKES, JOHN PEABODY (MS, APRN, NP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PEABODY
Last Name:MIKES
Suffix:
Gender:M
Credentials:MS, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 NORWELL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3958
Mailing Address - Country:US
Mailing Address - Phone:614-893-3668
Mailing Address - Fax:
Practice Address - Street 1:1237 NORWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3958
Practice Address - Country:US
Practice Address - Phone:614-893-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027339363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner