Individual
ADREIA JENICE JESSOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, CNM, IBCLC
Contact information
Practice address
300 OAK ST, KELSO, WA 98626
(360) 353-5511
(360) 353-5502
Mailing address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 353-5511
(360) 353-5502
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
RN00157790
WA
363LW0102X
Women's Health Nurse Practitioner
Primary
AP60799447
WA
367A00000X
Advanced Practice Midwife
AP60799447
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2105815
—
WA
01
—
AP60799447
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
01
—
RN00157790
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
09/08/2017
Last updated
02/14/2024
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