Provider Demographics
NPI:1346623048
Name:JURASIN, JESSICA RENAE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENAE
Last Name:JURASIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENAE
Other - Last Name:KOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN, RN
Mailing Address - Street 1:128 TOLOMEI DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1314
Mailing Address - Country:US
Mailing Address - Phone:360-581-6708
Mailing Address - Fax:360-346-2191
Practice Address - Street 1:600 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9560
Practice Address - Country:US
Practice Address - Phone:360-346-2222
Practice Address - Fax:360-346-2191
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60573932363LF0000X
WACO61324263101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)