Provider Demographics
NPI:1023308954
Name:JAHNER, SCOTT A (ARNP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:JAHNER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N MERIDIAN
Mailing Address - Street 2:STE 100 PMB 193
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4409
Mailing Address - Country:US
Mailing Address - Phone:253-340-5040
Mailing Address - Fax:
Practice Address - Street 1:1002 N MERIDIAN
Practice Address - Street 2:STE 100 PMB 193
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4409
Practice Address - Country:US
Practice Address - Phone:253-340-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60684722163W00000X
FLRN9313499163W00000X
FLARNP9313499363L00000X
WAAP60684723363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023308954Medicaid
FL003562300Medicaid