Provider Demographics
NPI:1588442933
Name:FOLEY, JEFFERY M (AGNP)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:M
Last Name:FOLEY
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 NE 132ND AVE # A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-3041
Mailing Address - Country:US
Mailing Address - Phone:503-957-5114
Mailing Address - Fax:
Practice Address - Street 1:2227 NE 132ND AVE # A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3041
Practice Address - Country:US
Practice Address - Phone:503-957-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10016082363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty