Provider Demographics
NPI:1851088736
Name:TEMPLE, JOHN NATHANIEL III (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NATHANIEL
Last Name:TEMPLE
Suffix:III
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 1:5850 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2314
Mailing Address - Country:US
Mailing Address - Phone:610-297-1790
Mailing Address - Fax:
Practice Address - Street 1:775 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5002
Practice Address - Country:US
Practice Address - Phone:717-782-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical