Provider Demographics
NPI:1346778271
Name:PRICE, JEREMIAH HENDRICKS (PA)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:HENDRICKS
Last Name:PRICE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 S OLYMPIA ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-4356
Mailing Address - Country:US
Mailing Address - Phone:509-366-7511
Mailing Address - Fax:
Practice Address - Street 1:2828 S OLYMPIA ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-4356
Practice Address - Country:US
Practice Address - Phone:509-366-7511
Practice Address - Fax:509-366-7511
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical