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General NPI Number Information
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NPI Number | 1972195337
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Entity Type | Individual
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Provider Name | JESSICA ELLINGTON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1001 SW DISK DR STE 250
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City | BEND
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State | OR
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Zip | 97702-3754
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Country | US
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Telephone | 541-293-1325
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Fax |
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Provider Business Mailing Address
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Address Line | 600 SUN TEMPLE DR
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City | MADISON
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State | AL
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Zip | 35758-8643
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Country | US
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Telephone | 256-975-4291
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-151047
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 313139
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10031835
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1-151047
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License Number State | AL
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