Healthcare Provider Details

I. General information

NPI: 1053866632
Provider Name (Legal Business Name): MS. JENNIFER LEE BARDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 02/09/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GEORGE WASHINGTON WAY
RICHLAND WA
99354-2626
US

IV. Provider business mailing address

PO BOX 2928
PORTLAND WA
98722-2928
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax: 509-622-2707
Mailing address:
  • Phone: 252-075-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201606733
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: