Provider Demographics
NPI:1649423542
Name:MINEFEE, JARRED DEWAYNE (PA)
Entity Type:Individual
Prefix:
First Name:JARRED
Middle Name:DEWAYNE
Last Name:MINEFEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:283 MADONNA ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405
Mailing Address - Country:US
Mailing Address - Phone:805-549-8880
Mailing Address - Fax:805-549-8743
Practice Address - Street 1:283 MADONNA ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405
Practice Address - Country:US
Practice Address - Phone:805-549-8880
Practice Address - Fax:805-549-8743
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant