Provider Demographics
NPI:1134400732
Name:WILCOX, JESSICA BRIE (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BRIE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4324
Mailing Address - Country:US
Mailing Address - Phone:360-336-5658
Mailing Address - Fax:360-336-5655
Practice Address - Street 1:916 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4324
Practice Address - Country:US
Practice Address - Phone:360-336-5658
Practice Address - Fax:360-336-5655
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60242057363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner