Provider Demographics
NPI:1316323777
Name:KAUFFMAN, EDWARD JAY
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAY
Last Name:KAUFFMAN
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 1:2102 E MCLOUGHLIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4130
Mailing Address - Country:US
Mailing Address - Phone:360-519-5314
Mailing Address - Fax:360-251-0321
Practice Address - Street 1:2102 E MCLOUGHLIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4130
Practice Address - Country:US
Practice Address - Phone:360-519-5314
Practice Address - Fax:360-251-0321
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61151041363L00000X
GARN210225363LG0600X, 363LA2100X
NC5011543363L00000X, 363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
GAPENDINGMedicare PIN