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

Jon Derik Mortensen, PAC

Individual provider Medical Physician Assistant · NPI 1407930456

Jon Derik Mortensen, PAC is a Physician Assistant in Lakewood, Washington. Qualified in 2006, 20 years ago. Practices with Community Health Care, a 72-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
20
Licensed in
WA
In the registry since
2006
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

10510 Gravelly Lake Dr Community Health Care - Lakewood Clinic
Lakewood, WA 98499
Phone: (253) 589-7030
Fax: (253) 589-7033
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA10005073 (WA)

Record details

NPI number1407930456
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedOctober 25, 2006
Last updated in NPPESJune 14, 2012
Mailing address1019 Pacific Ave Ste 300, Attn Hr, Tacoma, WA 98402-4488

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 Community Health Care — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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