Healthcare Provider Details

I. General information

NPI: 1932067600
Provider Name (Legal Business Name): WESTERN ROOTS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8154 11TH ST STE 1
TERREBONNE OR
97760-8866
US

IV. Provider business mailing address

PO BOX 52
REDMOND OR
97756-0007
US

V. Phone/Fax

Practice location:
  • Phone: 541-920-0727
  • Fax: 541-325-4312
Mailing address:
  • Phone: 541-920-0727
  • Fax: 541-325-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY JORDAN
Title or Position: OWNER/MANAGER
Credential: FNP
Phone: 541-920-0727