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General NPI Number Information
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NPI Number | 1740665694
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Entity Type | Individual
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Provider Name | JENNIFER MICHELLE GOKA PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 10100 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 971-978-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 272 W MAPLE ST
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City | WASHOUGAL
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State | WA
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Zip | 98671-8996
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Country | US
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Telephone | 971-978-7445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.PA.70013922
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA225917
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License Number State | OR
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