Healthcare Provider Details

I. General information

NPI: 1942823679
Provider Name (Legal Business Name): JESSICA ANN MCDONNELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ANN UECKER

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 5TH ST
MOUNT VERNON WA
98274-3942
US

IV. Provider business mailing address

1415 E KINCAID ST
MOUNT VERNON WA
98274-4126
US

V. Phone/Fax

Practice location:
  • Phone: 360-814-7300
  • Fax:
Mailing address:
  • Phone: 360-428-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61519798
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: