Healthcare Provider Details

I. General information

NPI: 1518649771
Provider Name (Legal Business Name): GAVIN A. BAKKER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 KERN WAY STE D
YAKIMA WA
98902-7805
US

IV. Provider business mailing address

214 N 63RD AVE
YAKIMA WA
98908-2703
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-4303
  • Fax: 509-469-2441
Mailing address:
  • Phone: 509-961-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61491164
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN60835963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: