Healthcare Provider Details

I. General information

NPI: 1891028668
Provider Name (Legal Business Name): JONATHAN D PATTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E KINCAID ST
MOUNT VERNON WA
98274-4127
US

IV. Provider business mailing address

PO BOX 421
SPOKANE WA
99210-0421
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-6434
  • Fax: 360-848-4233
Mailing address:
  • Phone: 509-474-3568
  • Fax: 509-474-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-107376
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60109938
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: