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NPI Code Detail

MEDICARE: MANDY L JAMES PA-C

MEDICARE: MANDY L JAMES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA61243759WA
2363A00000XPhysician AssistantPA161600OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285934406
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDY L JAMES PA-C
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12345 SW HORIZON BLVD STE 57
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-9475
Country : US
Telephone Number : 503-216-8820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2010
Last Update Date : 04/22/2025

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