Provider Demographics
NPI:1609077528
Name:GEPHART, JOY CHIYO DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:CHIYO DAWN
Last Name:GEPHART
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 1:1825 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1939
Mailing Address - Country:US
Mailing Address - Phone:503-357-2136
Mailing Address - Fax:503-359-5479
Practice Address - Street 1:1825 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1939
Practice Address - Country:US
Practice Address - Phone:503-357-2136
Practice Address - Fax:503-359-5479
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR137561Medicare PIN