MEDICARE: MRS. JESSICA HERNANDEZ CHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		OR

General Provider Information

NPI Number	:	1700721396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA HERNANDEZ CHW

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-0031
Country	:	US
Telephone Number	:	541-967-3888
Fax Number	:	541-924-6911

Provider Business Practice Location Address
First Line	:	1050 7TH AVE SW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1924
Country	:	US
Telephone Number	:	541-967-3888
Fax Number	:	541-924-6911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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