Provider Demographics
NPI:1427539949
Name:CALHOUN, JESSICA ROBERTS (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROBERTS
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARY
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1810 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2940
Mailing Address - Country:US
Mailing Address - Phone:858-361-4213
Mailing Address - Fax:
Practice Address - Street 1:MCCLURE MIDDLE SCHOOL
Practice Address - Street 2:1915 1ST AVE W
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119
Practice Address - Country:US
Practice Address - Phone:206-252-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60794572163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice