Healthcare Provider Details

I. General information

NPI: 1346778271
Provider Name (Legal Business Name): JEREMIAH HENDRICKS PRICE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 S OLYMPIA ST
KENNEWICK WA
99337-4356
US

IV. Provider business mailing address

2828 S OLYMPIA ST
KENNEWICK WA
99337-4356
US

V. Phone/Fax

Practice location:
  • Phone: 509-366-7511
  • Fax: 509-366-7511
Mailing address:
  • Phone: 509-366-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60782911
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: