Healthcare Provider Details

I. General information

NPI: 1457896664
Provider Name (Legal Business Name): JASON EDWARD PORTELL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15605 E SPRAGUE AVE
SPOKANE VALLEY WA
99037-8901
US

IV. Provider business mailing address

15605 E SPRAGUE AVE
SPOKANE VALLEY WA
99037-8901
US

V. Phone/Fax

Practice location:
  • Phone: 509-598-7820
  • Fax: 509-228-6101
Mailing address:
  • Phone: 509-598-7820
  • Fax: 509-228-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61681076
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: