MEDICARE: MS. JESSICA A. BLACKWELL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AP30005441	WA

General Provider Information

NPI Number	:	1902859895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA A. BLACKWELL ARNP

Provider Business Mailing Address
First Line	:	3419 E ELENA LN
Second Line	:
City	:	CHATTAROY
State	:	WA
Zip	:	99003-5121
Country	:	US
Telephone Number	:	509-960-6527
Fax Number	:	833-989-2072

Provider Business Practice Location Address
First Line	:	3419 E ELENA LN
Second Line	:
City	:	CHATTAROY
State	:	WA
Zip	:	99003-5121
Country	:	US
Telephone Number	:	509-960-6527
Fax Number	:	833-989-2072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/01/2022

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