Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carly Jane King Gravel

Individual provider Medical Physician Assistant · NPI 1629635008

Carly Jane King Gravel is a Physician Assistant in Portland, Oregon. Graduated from Stanford University School of Medicine in 2012, 14 years ago. Practices with University Professional Services, a 1,704-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in California and Oregon.

Years since qualifying
14
Trained at
Stanford University School of Medicine
Licensed in
CA, OR
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

3303 S Bond Ave
Portland, OR 97239-4501
Phone: (503) 494-6594
Fax: (503) 494-5385
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 Pasteur Dr, Stanford, CA 94305-2200 — (650) 498-6000

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA207931 (OR)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 58259 (CA)

Record details

NPI number1629635008
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 21, 2019
Last updated in NPPESSeptember 18, 2025
Certification dateSeptember 18, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolSTANFORD UNIVERSITY SCHOOL OF MEDICINE
Graduated 2012 (14 years in practice)
Group practice University Professional Services — 1704 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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