Healthcare Provider Details

I. General information

NPI: 1366227399
Provider Name (Legal Business Name): JESSICA RACHELE VAN VALKENBURG DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MARSHALL RN

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 ERRECART BLVD
ELKO NV
89801-8333
US

IV. Provider business mailing address

727 AESOP DR
SPRING CREEK NV
89815-7066
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-5151
  • Fax:
Mailing address:
  • Phone: 307-371-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number836713
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: