Healthcare Provider Details

I. General information

NPI: 1578076972
Provider Name (Legal Business Name): JASON SIKES APN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 LAUREL ST
BEAUMONT TX
77707-2216
US

IV. Provider business mailing address

3650 LAUREL ST
BEAUMONT TX
77707-2216
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax: 409-839-3720
Mailing address:
  • Phone: 409-838-0346
  • Fax: 409-839-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135783
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: