Healthcare Provider Details

I. General information

NPI: 1023308954
Provider Name (Legal Business Name): SCOTT A JAHNER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MERIDIAN AVE E STE 6 PMB 111
MILTON WA
98354-7002
US

IV. Provider business mailing address

1002 N MERIDIAN STE 100 PMB 193
PUYALLUP WA
98371-4409
US

V. Phone/Fax

Practice location:
  • Phone: 253-340-5040
  • Fax: 253-323-9012
Mailing address:
  • Phone: 253-340-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60684723
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9313499
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60684722
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9313499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: