Healthcare Provider Details

I. General information

NPI: 1164576617
Provider Name (Legal Business Name): GWYNETH THERESA JONES DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 NE 109TH CT STE A
VANCOUVER WA
98662-6104
US

IV. Provider business mailing address

1933 MAIN ST APT 104
OREGON CITY OR
97045-1099
US

V. Phone/Fax

Practice location:
  • Phone: 360-727-1641
  • Fax: 877-349-1923
Mailing address:
  • Phone: 503-734-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201506920NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: