Healthcare Provider Details

I. General information

NPI: 1932866837
Provider Name (Legal Business Name): MELODY JONES, PMHNP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 SW TUALATIN SHERWOOD RD
TUALATIN OR
97062-8620
US

IV. Provider business mailing address

4860 CENTERWOOD ST
LAKE OSWEGO OR
97035-8203
US

V. Phone/Fax

Practice location:
  • Phone: 971-356-4110
  • Fax:
Mailing address:
  • Phone: 971-356-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELODY BECKER JONES
Title or Position: OWNER
Credential:
Phone: 971-356-4110