Provider Demographics
NPI:1740515097
Name:NEHS, SKYE ANTHONY (PAC)
Entity type:Individual
Prefix:DR
First Name:SKYE
Middle Name:ANTHONY
Last Name:NEHS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24988 SE STARK ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8325
Mailing Address - Country:US
Mailing Address - Phone:503-413-7162
Mailing Address - Fax:503-674-4140
Practice Address - Street 1:24988 SE STARK ST STE 300
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8325
Practice Address - Country:US
Practice Address - Phone:503-413-7162
Practice Address - Fax:503-674-4140
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1683175F00000X
ORPA174474363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500692934Medicaid
WA2048411Medicaid
WA2048411Medicaid
OR183979Medicare PIN