Provider Demographics
NPI:1538744453
Name:HYDE, JERAD PAUL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JERAD
Middle Name:PAUL
Last Name:HYDE
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 AVENUE F N
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-9573
Mailing Address - Country:US
Mailing Address - Phone:361-404-1751
Mailing Address - Fax:
Practice Address - Street 1:720 AVENUE F N
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-9573
Practice Address - Country:US
Practice Address - Phone:361-404-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily