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

Mr. Tyler R Van Wagenen, PA

Individual provider Physician Assistant · NPI 1700656352

Mr. Tyler R Van Wagenen, PA is a Physician Assistant in Ontario, Oregon. Qualified in 2023, 3 years ago. Practices with Valley Family Health Care Inc, a 45-clinician group and accepts Medicare assignment. Licensed in Idaho and Oregon.

Years since qualifying
3
Licensed in
ID, OR
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2327 SW 4th Ave
Ontario, OR 97914-1851
Phone: (541) 889-2340
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA219187 (OR)
Physician Assistant Taxonomy 363A00000X · Licence PA2766 (ID)

Record details

NPI number1700656352
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedJanuary 4, 2024
Last updated in NPPESJanuary 14, 2026
Certification dateJanuary 14, 2026

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Valley Family Health Care Inc — 45 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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