=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700880150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY P O'NEILL PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2005
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 410
-----------------------------------------------------
City | NEAH BAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98357-0410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-645-2233
-----------------------------------------------------
Fax | 360-645-2723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 410
-----------------------------------------------------
City | NEAH BAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98357-0410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-645-2233
-----------------------------------------------------
Fax | 360-645-2723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA10004128
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------