Healthcare Provider Details

I. General information

NPI: 1194208256
Provider Name (Legal Business Name): JAMIE L JORDAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE L GURRAD

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19120 SE 34TH ST STE 201
VANCOUVER WA
98683-1430
US

IV. Provider business mailing address

19120 SE 34TH ST STE 201
VANCOUVER WA
98683-1430
US

V. Phone/Fax

Practice location:
  • Phone: 360-906-1190
  • Fax: 360-906-1193
Mailing address:
  • Phone: 360-991-0647
  • Fax: 360-906-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61458047
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60667260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: