Healthcare Provider Details

I. General information

NPI: 1780074096
Provider Name (Legal Business Name): JESSICA GROGAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N VERCLER RD
SPOKANE VALLEY WA
99216-0178
US

IV. Provider business mailing address

14817 E 30TH AVE
SPOKANE VALLEY WA
99037-8057
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax:
Mailing address:
  • Phone: 509-599-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60536350
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberAP60536350
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: