Vandiver, Johnny Ray

Vandiver, Johnny Ray is an individual health care provider with primary practice located at 12233 24Th Street , Joint Base Lewis Mchord WA 98433. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Vandiver, Johnny Ray can be contacted via phone (253) 477-5734.

Contact Information

Primary practice address
12233 24Th Street Joint Base Lewis Mchord WA 98433
Phone: (253) 477-5734
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1629059126
LBN Legal business name Vandiver, Johnny Ray
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2005
Last updated Nov 7th, 2012 - about 13 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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