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

Jason Mayberry, PAC

Individual provider Physician Assistant · NPI 1255403861

Jason Mayberry, PAC is a Physician Assistant in Spokane, Washington. Qualified in 2006, 20 years ago. Practices with Providence Health and Services-Wa, a 25-clinician group and accepts Medicare assignment. Licensed in California and Washington.

Years since qualifying
20
Licensed in
CA, WA
In the registry since
2006
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

62 W 7th Ave Ste 110
Spokane, WA 99204-2321
Phone: (509) 462-6485
Fax: (509) 462-5059
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA60698165 (WA)
Physician Assistant Taxonomy 363A00000X · Licence PA19289 (CA)

Record details

NPI number1255403861
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedNovember 15, 2006
Last updated in NPPESJune 17, 2021
Certification dateJune 17, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Providence Health And Services-Wa — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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