Provider Demographics
NPI:1154032696
Name:HEMPHILL, JON DAVID
Entity type:Individual
Prefix:
First Name:JON
Middle Name:DAVID
Last Name:HEMPHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BARNEY DR
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-8429
Mailing Address - Country:US
Mailing Address - Phone:570-768-5740
Mailing Address - Fax:
Practice Address - Street 1:FCI ALLENWOOD
Practice Address - Street 2:RT 15, 2 MILES N OF ALLENWOOD
Practice Address - City:WHITEDEEAR
Practice Address - State:PA
Practice Address - Zip Code:17810
Practice Address - Country:US
Practice Address - Phone:570-547-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant