Provider Demographics
NPI:1932332236
Name:HOUGHTON, JODI CARLEEN (ARNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:CARLEEN
Last Name:HOUGHTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:CARLEEN
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2077
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:2101 NE 139TH ST
Practice Address - Street 2:SUITE 450
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2309
Practice Address - Country:US
Practice Address - Phone:360-487-4848
Practice Address - Fax:360-487-4850
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60098102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60098102OtherWA LICENSE
WAPENDINGMedicaid
WAAP60098102OtherWA LICENSE