Healthcare Provider Details

I. General information

NPI: 1235763129
Provider Name (Legal Business Name): SHELBY LYNN JENCK APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY LYNN PORTER APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PACIFIC AVE
TILLAMOOK OR
97141-3926
US

IV. Provider business mailing address

PO BOX 489
TILLAMOOK OR
97141-0489
US

V. Phone/Fax

Practice location:
  • Phone: 503-842-3900
  • Fax: 503-842-3903
Mailing address:
  • Phone: 503-842-3900
  • Fax: 503-842-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10016013
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10016013
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: