Jessica Anne Atterbury

Key facts

NPI

1063196863

Entity type

Individual (NPI type 1)

Primary specialty

Addiction (Substance Use Disorder) Counselor 101YA0400X

Practice address

3099 NE Diamond Lake Blvd
Roseburg, OR 97470-3655

Phone

(541) 673-3469

NPI assigned

Jun 12, 2023

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

Other names

• Jessica Shinn Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 18, 2025.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1063196863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1121",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700254",
            "telephone_number": "541-672-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3099 NE DIAMOND LAKE BLVD",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974703655",
            "telephone_number": "541-673-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATTERBURY",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-12",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SHINN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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