Healthcare Provider Details

I. General information

NPI: 1669087367
Provider Name (Legal Business Name): VILLAGE HEALTH TELEHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 E ELENA LN
CHATTAROY WA
99003-5121
US

IV. Provider business mailing address

3419 E ELENA LN
CHATTAROY WA
99003-5121
US

V. Phone/Fax

Practice location:
  • Phone: 509-960-6527
  • Fax: 833-989-2072
Mailing address:
  • Phone: 509-960-6527
  • Fax: 833-989-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA A. BLACKWELL
Title or Position: OWNER AND PROVIDER
Credential: APRN
Phone: 509-960-6527