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General NPI Number Information
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NPI Number | 1063826212
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Entity Type | Individual
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Provider Name | JESSICA DAWN YACQUES APRN,FNP, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 257 MADISON AVE SW SUITE 209
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City | CORVALLIS
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State | OR
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Zip | 97333-4757
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Country | US
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Telephone | 614-420-5093
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Fax | 971-233-6398
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Provider Business Mailing Address
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Address Line | 257 MADISON AVE SW SUITE 209
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City | CORVALLIS
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State | OR
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Zip | 97333-4757
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Country | US
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Telephone | 614-420-5093
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Fax | 971-233-6398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10043053
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10043053
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License Number State | OR
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