Provider Demographics
NPI:1932852233
Name:GODWIN, JARED M (PA-C)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:M
Last Name:GODWIN
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 1:16259 SYLVESTER RD SW STE 501
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3059
Mailing Address - Country:US
Mailing Address - Phone:206-243-1100
Mailing Address - Fax:206-431-0835
Practice Address - Street 1:16259 SYLVESTER RD SW STE 501
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3059
Practice Address - Country:US
Practice Address - Phone:206-243-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.61257805363A00000X
WAPA61257805363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant