Provider Demographics
NPI:1194164293
Name:CREEKMORE, JEREMY WAYNE (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WAYNE
Last Name:CREEKMORE
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 106
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5310
Mailing Address - Country:US
Mailing Address - Phone:808-675-8888
Mailing Address - Fax:808-999-7610
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 106
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5310
Practice Address - Country:US
Practice Address - Phone:808-675-8888
Practice Address - Fax:808-999-7610
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-75611163W00000X
HIAPRN-2678363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse