Provider Demographics
NPI:1962554543
Name:SEGUIN, JACKIE KAY (FNP)
Entity type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:KAY
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 NE MULTNOMAH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1916
Mailing Address - Country:US
Mailing Address - Phone:503-231-7216
Mailing Address - Fax:
Practice Address - Street 1:3231 SE 50TH AVE
Practice Address - Street 2:PLANNED PARENTHOOD OF THE COLUMBIA WILLAMETTE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:503-775-0861
Practice Address - Fax:503-788-7285
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000033522N1FNPPP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR263475OtherOMAP
131475OtherPIN
OR263475OtherOMAP