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General NPI Number Information
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NPI Number | 1518649771
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Entity Type | Individual
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Provider Name | GAVIN A. BAKKER ARNP
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Gender | Male
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 3810 KERN WAY STE D
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City | YAKIMA
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State | WA
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Zip | 98902-7805
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Country | US
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Telephone | 509-248-4303
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Fax | 509-469-2441
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Provider Business Mailing Address
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Address Line | 214 N 63RD AVE
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City | YAKIMA
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State | WA
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Zip | 98908-2703
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Country | US
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Telephone | 509-961-1850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP61491164
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN60835963
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License Number State | WA
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