Individual
MRS. JENNESSA OFFUTT GROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
700 NE 87TH AVE # 260, VANCOUVER, WA 98664-1913
(360) 882-2778
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
(360) 604-1770
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60651055
WA
363LF0000X
Family Nurse Practitioner
Primary
AP60882886
WA
363LP2300X
Primary Care Nurse Practitioner
60882886
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2134328
—
WA
Enumeration date
12/13/2017
Last updated
04/30/2025
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