Healthcare Provider Details

I. General information

NPI: 1700880150
Provider Name (Legal Business Name): JAY P O'NEILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 410
NEAH BAY WA
98357-0410
US

IV. Provider business mailing address

PO BOX 410
NEAH BAY WA
98357-0410
US

V. Phone/Fax

Practice location:
  • Phone: 360-645-2233
  • Fax: 360-645-2723
Mailing address:
  • Phone: 360-645-2233
  • Fax: 360-645-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004128
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: