Provider Demographics
NPI:1114932886
Name:JEFFERY, DARCY L (PA-C)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:L
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:L
Other - Last Name:KLIEWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004951363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8459315Medicaid
WA8942125OtherCV
WA0211695OtherL&I
WAG8863767Medicare PIN
WA8942125OtherCV
WA0211695OtherL&I