Provider Demographics
NPI:1376820688
Name:MYHRE, JESSICA NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:MYHRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:MYHRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:320 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3207
Mailing Address - Country:US
Mailing Address - Phone:360-322-1281
Mailing Address - Fax:360-228-7084
Practice Address - Street 1:303 W 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-5904
Practice Address - Country:US
Practice Address - Phone:360-452-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60337758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine