Provider Demographics
NPI:1578930731
Name:FIFE, JARED K (PA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:K
Last Name:FIFE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-1229
Mailing Address - Country:US
Mailing Address - Phone:530-623-4186
Mailing Address - Fax:530-623-4397
Practice Address - Street 1:31 EASTER AVE
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-1305
Practice Address - Country:US
Practice Address - Phone:530-623-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
UT9491002-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical