Provider Demographics
NPI:1366227399
Name:VAN VALKENBURG, JESSICA RACHELE (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHELE
Last Name:VAN VALKENBURG
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:727 AESOP DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-7066
Mailing Address - Country:US
Mailing Address - Phone:307-371-2539
Mailing Address - Fax:
Practice Address - Street 1:2001 ERRECART BLVD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8333
Practice Address - Country:US
Practice Address - Phone:775-738-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV836713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health