Healthcare Provider Details

I. General information

NPI: 1376660597
Provider Name (Legal Business Name): JASON KENT WINEBARGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 200
BEND OR
97701-4281
US

IV. Provider business mailing address

4636 SJODIN LN
KLAMATH FALLS OR
97603-6899
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-3344
  • Fax: 541-382-1681
Mailing address:
  • Phone: 541-885-5546
  • Fax: 541-885-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00709
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00709
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: