Provider Demographics
NPI:1740542919
Name:BENEDICT, JESSICA D (WHCNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:D
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHCNP
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-734-3700
Mailing Address - Fax:
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6772
Practice Address - Country:US
Practice Address - Phone:503-734-3700
Practice Address - Fax:503-473-8462
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250073NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500645846Medicaid
ORR165612OtherMEDICARE PTAN
OR500645846Medicaid