Provider Demographics
NPI:1386374619
Name:NEBEKER, JOSEPH ANDREW (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDREW
Last Name:NEBEKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:ANDREW
Other - Last Name:NEBEKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:921 S 8TH AVE STOP 8253
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0002
Mailing Address - Country:US
Mailing Address - Phone:208-282-4726
Mailing Address - Fax:
Practice Address - Street 1:100 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3692
Practice Address - Country:US
Practice Address - Phone:509-933-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program