Healthcare Provider Details

I. General information

NPI: 1407744501
Provider Name (Legal Business Name): JESSICA ANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 LAKE BELLEVUE DR STE 100
BELLEVUE WA
98005-2480
US

IV. Provider business mailing address

901 12TH AVE
SEATTLE WA
98122-4411
US

V. Phone/Fax

Practice location:
  • Phone: 206-793-7168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70166791-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: