Provider Demographics
NPI:1376660597
Name:WINEBARGER, JASON KENT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:KENT
Last Name:WINEBARGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 SJODIN LN
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-6899
Mailing Address - Country:US
Mailing Address - Phone:541-885-5546
Mailing Address - Fax:541-885-5546
Practice Address - Street 1:4636 SJODIN LN
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-6899
Practice Address - Country:US
Practice Address - Phone:541-885-5546
Practice Address - Fax:541-885-5546
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00709363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
003645OtherRAILROAD MEDICARE
OR261198Medicaid
610098800OtherUS DEPT OF LABOR
S93399Medicare UPIN
OR120733Medicare ID - Type Unspecified
610098800OtherUS DEPT OF LABOR