Provider Demographics
NPI:1063826212
Name:YACQUES, JESSICA DAWN (APRN,FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:YACQUES
Suffix:
Gender:F
Credentials:APRN,FNP, PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:257 MADISON AVE SW SUITE 209
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4757
Mailing Address - Country:US
Mailing Address - Phone:614-420-5093
Mailing Address - Fax:971-233-6398
Practice Address - Street 1:257 MADISON AVE SW SUITE 209
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4757
Practice Address - Country:US
Practice Address - Phone:614-420-5093
Practice Address - Fax:971-233-6398
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10043053363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily