Provider Demographics
NPI:1518071372
Name:VEATCH-JANIN, JODY J (PA-C)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:J
Last Name:VEATCH-JANIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:J
Other - Last Name:VEATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5500 OLYMPIC DR STE H105
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1491
Mailing Address - Country:US
Mailing Address - Phone:253-228-3626
Mailing Address - Fax:253-514-6007
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3300
Practice Address - Fax:253-596-3301
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2026363A00000X
WAPA60401344363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2104464Medicaid
CO48157546Medicaid
WAG8924547Medicare PIN
CO275299YLB8Medicare PIN