Provider Demographics
NPI:1326005646
Name:HENKE, JONATHAN P (PAC, MPH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:P
Last Name:HENKE
Suffix:
Gender:M
Credentials:PAC, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 KARL RD NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-9458
Mailing Address - Country:US
Mailing Address - Phone:509-707-3317
Mailing Address - Fax:
Practice Address - Street 1:402 KARL RD NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-9458
Practice Address - Country:US
Practice Address - Phone:509-707-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10005308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0226041OtherL&I
WA849537Medicaid
WAP60065Medicare UPIN
WA849537Medicaid