Healthcare Provider Details

I. General information

NPI: 1689451015
Provider Name (Legal Business Name): JESSICA WADDLE ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NW 12TH AVENUE SUITE 107
BATTLE GROUND WA
98604
US

IV. Provider business mailing address

101 NW 12TH AVE STE 107
BATTLE GROUND WA
98604-9141
US

V. Phone/Fax

Practice location:
  • Phone: 360-723-0528
  • Fax: 360-995-0081
Mailing address:
  • Phone: 360-723-0528
  • Fax: 360-995-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61520261
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61520261
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60326225
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: