Provider Demographics
NPI:1811426521
Name:WHEELER, JESSICA GUPTILL (ARNP)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:GUPTILL
Last Name:WHEELER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:EDITH
Other - Last Name:GUPTILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 UNION AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2060
Mailing Address - Country:US
Mailing Address - Phone:360-292-3059
Mailing Address - Fax:
Practice Address - Street 1:400 UNION AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2060
Practice Address - Country:US
Practice Address - Phone:360-292-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60764043363LF0000X
WAAP60991321364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily