Provider Demographics
NPI:1285255851
Name:JALBERT, DARBY SAMANTHA (PA-C)
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:SAMANTHA
Last Name:JALBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LIBERTY ST NE STE 110
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-8381
Mailing Address - Country:US
Mailing Address - Phone:503-371-1756
Mailing Address - Fax:503-584-7971
Practice Address - Street 1:2480 LIBERTY ST NE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8381
Practice Address - Country:US
Practice Address - Phone:503-371-1756
Practice Address - Fax:503-584-7971
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA196335363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical