Provider Demographics
NPI:1912250754
Name:ROSS, JESSICA LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:600 OAKESDALE AVE SW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5226
Mailing Address - Country:US
Mailing Address - Phone:425-228-4540
Mailing Address - Fax:425-228-4540
Practice Address - Street 1:600 OAKESDALE AVE SW
Practice Address - Street 2:SUITE 104
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5226
Practice Address - Country:US
Practice Address - Phone:425-228-4540
Practice Address - Fax:425-228-4540
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60316263363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health