Provider Demographics
NPI:1407358450
Name:JARRELL, CAILIN KELLY (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CAILIN
Middle Name:KELLY
Last Name:JARRELL
Suffix:
Gender:F
Credentials:FNP-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 1:12503 SE MILL PLAIN BLVD STE 123
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4007
Mailing Address - Country:US
Mailing Address - Phone:360-334-9942
Mailing Address - Fax:425-242-3683
Practice Address - Street 1:12503 SE MILL PLAIN BLVD STE 123
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4007
Practice Address - Country:US
Practice Address - Phone:360-334-9942
Practice Address - Fax:425-242-3683
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201801551NP-PP363LF0000X
WAAP61412088363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201801551NP-PPOtherOREGON NP LICENSE