Provider Demographics
NPI:1750793618
Name:LYBARGER, JOCELYN (PA-C)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:LYBARGER
Suffix:
Gender:F
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 1:10956 DONNER PASS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4860
Mailing Address - Country:US
Mailing Address - Phone:530-582-6400
Mailing Address - Fax:530-582-6991
Practice Address - Street 1:10956 DONNER PASS RD STE 130
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4860
Practice Address - Country:US
Practice Address - Phone:530-582-6400
Practice Address - Fax:530-582-6991
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57912363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant