Healthcare Provider Details

I. General information

NPI: 1578859393
Provider Name (Legal Business Name): HEATHER WORTHINGTON PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER HANDLEY

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE WASHINGTON ST
PULLMAN WA
99164-8803
US

IV. Provider business mailing address

PO BOX 5920
EUGENE OR
97405-0911
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax: 509-335-6223
Mailing address:
  • Phone: 307-660-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA158537
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1098019
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: