MEDICARE: JESS CALOHAN DNP, PMHNP-BC, FAAN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30007053	WA

General Provider Information

NPI Number	:	1992813679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS CALOHAN DNP, PMHNP-BC, FAAN

Provider Business Mailing Address
First Line	:	2 ARNOLD PALMER
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1722
Country	:	US
Telephone Number	:	509-280-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N 13TH ST
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-2077
Country	:	US
Telephone Number	:	360-358-3690
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/11/2023

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