Provider Demographics
NPI:1023385275
Name:VINCENT, JESSICA LACHMAN (PAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LACHMAN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 NE CUMULUS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8805
Mailing Address - Country:US
Mailing Address - Phone:503-472-6161
Mailing Address - Fax:503-434-6290
Practice Address - Street 1:2435 NE CUMULUS AVE STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8805
Practice Address - Country:US
Practice Address - Phone:503-472-6161
Practice Address - Fax:503-434-6290
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA156217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant