Healthcare Provider Details

I. General information

NPI: 1528651320
Provider Name (Legal Business Name): JAYMIE A STOVALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 560
BEAVERTON OR
97005-4791
US

IV. Provider business mailing address

10700 SW BEAVERTON HILLSDALE HWY STE 560
BEAVERTON OR
97005-4791
US

V. Phone/Fax

Practice location:
  • Phone: 986-270-4780
  • Fax: 986-234-7669
Mailing address:
  • Phone: 986-270-4780
  • Fax: 986-234-7669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP61426711
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number10008957
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number14286732-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: