Provider Demographics
NPI:1326458753
Name:YEAGER, JESSICA MARIE (PMHNP, DNP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:YEAGER
Suffix:
Gender:F
Credentials:PMHNP, DNP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:BERQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSICA BERQUIST
Mailing Address - Street 1:1413 CHARNELTON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3906
Mailing Address - Country:US
Mailing Address - Phone:541-777-8879
Mailing Address - Fax:541-942-9310
Practice Address - Street 1:1413 CHARNELTON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3906
Practice Address - Country:US
Practice Address - Phone:541-777-8879
Practice Address - Fax:541-391-5934
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201800903RN163W00000X
OR201801007NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500739182Medicaid