Provider Demographics
NPI:1194376293
Name:PRICE, JAZMYN NICOLE (WHNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JAZMYN
Middle Name:NICOLE
Last Name:PRICE
Suffix:
Gender:F
Credentials:WHNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 SE 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2654
Mailing Address - Country:US
Mailing Address - Phone:503-447-2258
Mailing Address - Fax:503-376-5062
Practice Address - Street 1:1002 SE 54TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2654
Practice Address - Country:US
Practice Address - Phone:034-472-2585
Practice Address - Fax:503-376-5062
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8424363LW0102X
OR202102920NP-PP363LP0808X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health