Stark, Jody A.

Stark, Jody A. is an individual health care provider with primary practice located at 932 W Idaho Ave Suite 100, Ontario OR 97914-2155. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Stark, Jody A. can be contacted via phone (541) 889-2244.

Contact Information

Primary practice address
932 W Idaho Ave Suite 100 Ontario OR 97914-2155
Phone: (541) 889-2244
Fax: (541) 889-2626
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 200550081NP Oregon
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 079043254N1 Oregon

Profile Details

NPI number 1851472989
LBN Legal business name Stark, Jody A.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2006
Last updated Oct 19th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851472989 NPPES
Oregon MEDICAID 500656154
Oregon MEDICAID 500614019

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