Provider Demographics
NPI:1588344246
Name:OGLE, JESSE OWEN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:OWEN
Last Name:OGLE
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:OWEN
Other - Last Name:SHARROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1934 N TEANAWAY DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7346
Mailing Address - Country:US
Mailing Address - Phone:740-755-6919
Mailing Address - Fax:
Practice Address - Street 1:1934 N TEANAWAY DR
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7346
Practice Address - Country:US
Practice Address - Phone:740-755-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66302363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health