Provider Demographics
NPI:1184485492
Name:BAUTISTA, JESSICA LILLIANA (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LILLIANA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BAUTISTA
Other - Last Name:NAGAOKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSICA NAGAOKA
Mailing Address - Street 1:9155 SW BARNES RD STE 238
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6629
Mailing Address - Country:US
Mailing Address - Phone:503-215-9297
Mailing Address - Fax:
Practice Address - Street 1:9155 SW BARNES RD STE 238
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-215-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10020493363LG0600X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care