Provider Demographics
NPI:1245696392
Name:READ, JACOB (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:READ
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CENTERPOINTE DR STE 400-0703
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8651
Mailing Address - Country:US
Mailing Address - Phone:406-860-5138
Mailing Address - Fax:835-213-5169
Practice Address - Street 1:5 CENTERPOINTE DR STE 400-0703
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8651
Practice Address - Country:US
Practice Address - Phone:406-860-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60650859363LP0808X
NMCNP-02824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily