Provider Demographics
NPI:1033677109
Name:GNIADEK, JESSICA RAE (PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:GNIADEK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58646 MCNULTY WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-6210
Mailing Address - Country:US
Mailing Address - Phone:503-397-5211
Mailing Address - Fax:
Practice Address - Street 1:58646 MCNULTY WAY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-6210
Practice Address - Country:US
Practice Address - Phone:503-397-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10033268363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health