Healthcare Provider Details

I. General information

NPI: 1598687444
Provider Name (Legal Business Name): NORTHLIGHT WELLNESS, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1401 21ST ST STE R
SACRAMENTO CA
95811-5226
US

V. Phone/Fax

Practice location:
  • Phone: 360-620-4435
  • Fax: 707-901-1344
Mailing address:
  • Phone: 360-620-4435
  • Fax: 707-901-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JORDAN STEPHENS
Title or Position: NURSE PRACTITIONER, OWNER
Credential: FNP-BC, PMHNP-BC
Phone: 360-620-4435