Provider Demographics
NPI:1811976251
Name:STEHN, JONATHAN KENNETH (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KENNETH
Last Name:STEHN
Suffix:
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 1:8507 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3421
Mailing Address - Country:US
Mailing Address - Phone:360-887-9494
Mailing Address - Fax:
Practice Address - Street 1:8507 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3421
Practice Address - Country:US
Practice Address - Phone:360-887-9494
Practice Address - Fax:360-887-9498
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6030363AM0700X, 363AS0400X, 363A00000X
WAPA61168147363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ017418Medicaid
AZ017418Medicaid