Provider Demographics
NPI:1255614160
Name:PIKE, DARLENA ROSE (FNP)
Entity type:Individual
Prefix:
First Name:DARLENA
Middle Name:ROSE
Last Name:PIKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NE 7TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1451
Mailing Address - Country:US
Mailing Address - Phone:541-314-4894
Mailing Address - Fax:541-314-4895
Practice Address - Street 1:1201 NE 7TH ST STE E
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1451
Practice Address - Country:US
Practice Address - Phone:541-314-4894
Practice Address - Fax:541-862-2806
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150132NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500642365Medicaid
ORR162018Medicare PIN