Provider Demographics
NPI:1033512116
Name:ALVORD, JONATHAN DREW (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DREW
Last Name:ALVORD
Suffix:
Gender:
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:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0719
Mailing Address - Country:US
Mailing Address - Phone:509-837-1617
Mailing Address - Fax:
Practice Address - Street 1:355 CHARDONNAY AVE
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-9521
Practice Address - Country:US
Practice Address - Phone:509-781-6366
Practice Address - Fax:509-781-6367
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007189363AM0700X
AZ6121363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100604Medicaid
AZZ185097Medicare PIN
AZZ185096Medicare PIN