Basic Information
| Provider Information | |||||||||
| NPI: | 1912250754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 OAKESDALE AVE SW | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252284540 | ||||||||
| FaxNumber: | 4252284540 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 OAKESDALE AVE SW | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252284540 | ||||||||
| FaxNumber: | 4252284540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2012 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP60316263 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.