Provider Demographics
NPI:1912269135
Name:COLWELL, JESSICA MARIE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:COLWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2609
Mailing Address - Country:US
Mailing Address - Phone:360-452-7891
Mailing Address - Fax:360-452-8087
Practice Address - Street 1:240 W FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2609
Practice Address - Country:US
Practice Address - Phone:360-452-7891
Practice Address - Fax:360-452-8087
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-1248207Q00000X
WAMD60565046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2046999Medicaid