Grace Lake

Physician Assistant · Newport, OR

Individual Active NPI

NPI number 1124752233

Practice location

930 SW Abbey St
Newport, OR 97365-4820
Phone
(541) 265-2244

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NPI record

NPI
1124752233
Entity type
Individual (Type 1)
Enumeration date
July 13, 2022
Last updated
November 8, 2024
Certified
November 8, 2024
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X PA221993 OR

About Grace Lake

Grace Lake is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 930 SW Abbey St, Newport, OR 97365-4820. The NPI number 1124752233 was assigned on July 13, 2022 and the record was last updated on November 8, 2024.

Grace Lake lists a license in the registry: #PA221993 (OR) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Grace Lake?

The NPI number is 1124752233.

What is the phone number of Grace Lake?

The phone number listed for the practice location is (541) 265-2244.

Where is Grace Lake located?

930 SW Abbey St, Newport, OR 97365-4820.

What is the taxonomy code for Grace Lake?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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