Provider Demographics
NPI:1902859895
Name:BLACKWELL, JESSICA A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:A
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3419 E ELENA LN
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-5121
Mailing Address - Country:US
Mailing Address - Phone:509-960-6527
Mailing Address - Fax:833-989-2072
Practice Address - Street 1:3419 E ELENA LN
Practice Address - Street 2:
Practice Address - City:CHATTAROY
Practice Address - State:WA
Practice Address - Zip Code:99003-5121
Practice Address - Country:US
Practice Address - Phone:509-960-6527
Practice Address - Fax:833-989-2072
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005441363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645755Medicaid
WA9645755Medicaid
WA5048140002Medicare NSC