Provider Demographics
NPI:1457505687
Name:WORTH, ERIN JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JESSICA
Last Name:WORTH
Suffix:
Gender:F
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 1:233 NW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2630
Mailing Address - Country:US
Mailing Address - Phone:503-223-6480
Mailing Address - Fax:503-721-7789
Practice Address - Street 1:233 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2630
Practice Address - Country:US
Practice Address - Phone:503-223-6480
Practice Address - Fax:503-721-7789
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60051139363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA 60051139OtherPHYSICIAN ASSISTANT LICENSE