Healthcare Provider Details

I. General information

NPI: 1487435384
Provider Name (Legal Business Name): JESSICA G NORTON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 4TH ST
LA GRANDE OR
97850-1906
US

IV. Provider business mailing address

PO BOX 3290
LA GRANDE OR
97850-7290
US

V. Phone/Fax

Practice location:
  • Phone: 541-663-3138
  • Fax: 541-975-5120
Mailing address:
  • Phone: 541-963-8421
  • Fax: 541-963-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10010788
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number10010788
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: