Provider Demographics
NPI:1457751760
Name:KINGSBURY, JESSICA (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S. PALATIVE HILL RD.
Mailing Address - Street 2:MSC 133
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-768-7165
Mailing Address - Fax:503-768-7167
Practice Address - Street 1:615 S. PALATIVE HILL RD.
Practice Address - Street 2:MSC 133
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219
Practice Address - Country:US
Practice Address - Phone:503-768-7165
Practice Address - Fax:503-768-7167
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405480NP-PP363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily