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

Nicole Weis, PA-C

Individual provider Physician Assistant · NPI 1760090666

Nicole Weis, PA-C is a Physician Assistant in Portland, Oregon. Qualified in 2020, 6 years ago. Practices with Legacy Clinics LLC, a 718-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
6
Licensed in
OR
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone: (503) 494-6813
Fax: (503) 494-1310
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2850 Se Powell Valley Rd Ste 100, Gresham, OR 97080-1495 — (503) 666-5050

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA201241 (OR)
Physician Assistant Taxonomy 363A00000X

Record details

NPI number1760090666
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJuly 16, 2020
Last updated in NPPESSeptember 13, 2023
Certification dateSeptember 13, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations14 on file with Medicare

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