Provider Demographics
NPI:1578632238
Name:MAYES, JOSHUA B (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:B
Last Name:MAYES
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 1:1900 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9073
Mailing Address - Country:US
Mailing Address - Phone:360-330-1897
Mailing Address - Fax:360-491-6328
Practice Address - Street 1:1900 COOKS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9073
Practice Address - Country:US
Practice Address - Phone:360-330-1897
Practice Address - Fax:360-786-9010
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004811363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8421166Medicaid
WAQ45087Medicare UPIN
WA8421166Medicaid