Provider Demographics
NPI:1700541315
Name:ADAMSON, JESSICA KAY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 SE 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4540
Mailing Address - Country:US
Mailing Address - Phone:509-237-8482
Mailing Address - Fax:
Practice Address - Street 1:6419 SE 134TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4540
Practice Address - Country:US
Practice Address - Phone:509-237-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202107809NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care