Provider Demographics
NPI:1649313065
Name:JARRETT, JARRE L (PAC)
Entity type:Individual
Prefix:MS
First Name:JARRE
Middle Name:L
Last Name:JARRETT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:ESTHER
Other - Middle Name:L
Other - Last Name:JARRETT-THRESHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:411 SUMMIT
Mailing Address - Street 2:PO BOX 178
Mailing Address - City:NORTHPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99157
Mailing Address - Country:US
Mailing Address - Phone:509-732-4252
Mailing Address - Fax:509-732-4318
Practice Address - Street 1:411 SUMMIT
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:WA
Practice Address - Zip Code:99157
Practice Address - Country:US
Practice Address - Phone:509-732-4252
Practice Address - Fax:509-732-4318
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004544363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0176704OtherLABOR & INDUSTRIES ID #
WA8376428Medicaid
WA8800106Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8800108Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8800110Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA8800112Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WAQ03121Medicare UPIN
WA8800104Medicare ID - Type UnspecifiedMEDICARE PART B ID NUMBER
WA0176704OtherLABOR & INDUSTRIES ID #