Healthcare Provider Details

I. General information

NPI: 1740665694
Provider Name (Legal Business Name): JENNIFER MICHELLE GOKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

272 W MAPLE ST
WASHOUGAL WA
98671-8996
US

V. Phone/Fax

Practice location:
  • Phone: 971-978-7445
  • Fax:
Mailing address:
  • Phone: 971-978-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.PA.70013922
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA225917
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: