Provider Demographics
NPI:1861435067
Name:PARKHURST, JANIS GRETA (PA-C)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:GRETA
Last Name:PARKHURST
Suffix:
Gender:F
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 1:264 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022-9421
Mailing Address - Country:US
Mailing Address - Phone:805-649-2677
Mailing Address - Fax:
Practice Address - Street 1:1600 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3722
Practice Address - Country:US
Practice Address - Phone:805-988-2843
Practice Address - Fax:805-988-2844
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13271363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN403182Medicaid
CAWNP6703AMedicare PIN
CAS63563Medicare UPIN
CAWNP6703BMedicare PIN