Provider Demographics
NPI:1861488868
Name:BURRIS-FISH, JAMEY L (NP-PP PSYCHIATRIC/MH)
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:L
Last Name:BURRIS-FISH
Suffix:
Gender:F
Credentials:NP-PP PSYCHIATRIC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 EXCHANGE ST STE 304
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3307
Mailing Address - Country:US
Mailing Address - Phone:503-325-8315
Mailing Address - Fax:503-325-8602
Practice Address - Street 1:2158 EXCHANGE ST STE 304
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3307
Practice Address - Country:US
Practice Address - Phone:503-325-8315
Practice Address - Fax:503-325-8602
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00159464163WP0808X
OR200750042NP363L00000X, 363LP2300X, 363LP0808X
WAAP30007010363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645276Medicaid
OR500699961Medicaid
WA8906041OtherCRIME VICTIMS
S30980Medicare UPIN