Healthcare Provider Details

I. General information

NPI: 1679423966
Provider Name (Legal Business Name): JESSICA GAMROTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E 19TH ST
THE DALLES OR
97058-3392
US

IV. Provider business mailing address

541 NE 20TH AVE STE 225
PORTLAND OR
97232-2895
US

V. Phone/Fax

Practice location:
  • Phone: 541-223-9018
  • Fax: 541-543-2531
Mailing address:
  • Phone: 503-963-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10056142
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: