Jacquelyn L Welborn, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

201907444NP-PP Issued in OR

Practice address

727 S Wahanna Rd
Seaside, OR 97138-7735

Phone

(503) 717-7060

NPI assigned

Aug 5, 2019

Last updated

Feb 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shoreline Counseling LLCGroup PAC ID 4587985049, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwelborn874029@oc.providencedirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shoreline Counseling LLC

  • Clinical Social Worker
  • Astoria, OR
  • NPI 1437548807
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Columbia Lutheran Charities

  dba Columbia Memorial Hospital

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1134146939
  Care Compare affiliation
• Columbia Lutheran Charities

  dba CMH Cardiology Clinic

  • Cardiovascular Disease Physician
  • Astoria, OR
  • NPI 1629378880

  Hospital

  Care Compare affiliation
• Columbia Lutheran Charities

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1700809761
  Care Compare affiliation
• Columbia Lutheran Charities

  dba Columbia Memorial Hospital

  • Surgery Physician
  • Astoria, OR
  • NPI 1821254129

  Hospital

  Care Compare affiliation
• Columbia Lutheran Charities

  • Surgery Physician
  • Astoria, OR
  • NPI 1871747659

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1689229940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3397",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 S WAHANNA RD",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971387735",
            "telephone_number": "503-717-7060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELBORN",
        "first_name": "JACQUELYN",
        "middle_name": "L",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-05",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "201907444NP-PP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201907444NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwelborn874029@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "727 S Wahanna Rd",
            "city": "Seaside",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971387735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jodi Vantress
• Kyle D Walker, MD
• Allison K Walkowski, FNP
• Amanda Washington, PA
• Julia Weinberg, PHD LPC
• James John Wilkinson, CRNA
• Katie Winters
• Wmso LLC (Holladay Drug #1139)
• Erin Zellmer
• Suzanne Marie Zillman, MS

• Psychiatric/Mental Health Nurse Practitioner in Seaside, OR
• Providers in Seaside, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.