Healthcare Provider Details

I. General information

NPI: 1710659628
Provider Name (Legal Business Name): JACQUELYN DENISE ADAMS DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 POCAHONTAS RD
BAKER CITY OR
97814-1464
US

IV. Provider business mailing address

3325 POCAHONTAS RD
BAKER CITY OR
97814-1464
US

V. Phone/Fax

Practice location:
  • Phone: 541-524-8000
  • Fax: 541-524-7955
Mailing address:
  • Phone: 541-519-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number202110723NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: