Provider Demographics
NPI:1518573377
Name:HEBERT, FAYTH TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:FAYTH
Middle Name:TAYLOR
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:222 NE PARK PLAZA DR
Practice Address - Street 2:STE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5895
Practice Address - Country:US
Practice Address - Phone:360-254-8025
Practice Address - Fax:360-254-8618
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2025-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI5197-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1173753OtherNATIONAL COMMISSION OF CERTIFIED PHYSICIAN ASSISTANTS