Provider Demographics
NPI:1861835654
Name:CRUMP, JACKLYNN (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JACKLYNN
Middle Name:
Last Name:CRUMP
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 1:258 SW 5TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2150
Mailing Address - Country:US
Mailing Address - Phone:541-203-0771
Mailing Address - Fax:458-206-7385
Practice Address - Street 1:258 SW 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2150
Practice Address - Country:US
Practice Address - Phone:541-203-0771
Practice Address - Fax:458-206-7385
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201902794NP-PP363LP2300X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care