Provider Demographics
NPI:1386498780
Name:YOO, JACQUELINE P (ARNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:P
Last Name:YOO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:P
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 290
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3067
Mailing Address - Country:US
Mailing Address - Phone:206-431-9771
Mailing Address - Fax:206-431-5484
Practice Address - Street 1:16233 SYLVESTER RD SW STE 290
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3067
Practice Address - Country:US
Practice Address - Phone:206-431-9771
Practice Address - Fax:206-431-5484
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61546551363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2285307Medicaid