Healthcare Provider Details

I. General information

NPI: 1992960785
Provider Name (Legal Business Name): JESSICA T TRAGESSER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA TRAGESSER WYNNE

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 PORTAL WAY
FERNDALE WA
98248-7833
US

IV. Provider business mailing address

1616 CORNWALL AVE STE 205
BELLINGHAM WA
98225-4642
US

V. Phone/Fax

Practice location:
  • Phone: 360-676-6177
  • Fax: 360-671-3574
Mailing address:
  • Phone: 360-676-6177
  • Fax: 360-527-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60054777
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00163760
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: