Provider Demographics
NPI:1457319584
Name:SLEDGE, JAMES NATHAN (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:NATHAN
Last Name:SLEDGE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:JAMEY
Other - Middle Name:NATHAN
Other - Last Name:SLEDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:546 N JEFFERSON LN STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-7104
Mailing Address - Country:US
Mailing Address - Phone:509-625-3700
Mailing Address - Fax:509-625-3747
Practice Address - Street 1:546 N JEFFERSON LN STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-625-3700
Practice Address - Fax:509-625-3747
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8420499Medicaid
ID807329800Medicaid
WA8850831Medicare ID - Type Unspecified
WA8420499Medicaid