Healthcare Provider Details

I. General information

NPI: 1134292964
Provider Name (Legal Business Name): JENNIFER CAMPBELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 SW CEDAR HILLS BLVD STE 200
BEAVERTON OR
97005-1435
US

IV. Provider business mailing address

2725 SW CEDAR HILLS BLVD STE 200
BEAVERTON OR
97005-1435
US

V. Phone/Fax

Practice location:
  • Phone: 503-214-1783
  • Fax:
Mailing address:
  • Phone: 503-352-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number924
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA172252
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: