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Contact Information

ANDREA L HUXTABLE, PAC
2701 NW VAUGHN ST STE 150
PORTLAND, OR97210-5379
 Phone: 503-229-8455
 Fax: 503-229-7028
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for ANDREA L HUXTABLE · (Female)

NPI Number 1205463312
Status Active
Credentials PAC
Entity Individual
Enumeration date 03/26/2020
Last updated 01/05/2026 - About 5 months ago
Sole proprietor 1 Yes
Identifiers
  • OR License # PA202788
  • OR Medicaid 500793275
  • WA Medicaid 2177842
Hospital affiliation(s)
  • LEGACY GOOD SAMARITAN MEDICAL CENTER - (Acute Care)
    1015 NW 22ND AVENUE, W121
    PORTLAND, OR 97210
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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