NPIMap

Organization Active NPI

Icare Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kent, WA
National Provider Identifier
1043021595
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
ICARE PSYCHIATRY PLLC
Practice address
19435 68TH Ave S Ste S102
Kent, WA 98032-2114
Phone
(253) 414-1983
Fax
(425) 616-1166
NPI assigned
Jan 15, 2025
Last updated
Jan 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Authorized official

Name
Keith Ho
Title
Office Manager
Phone
(714) 251-7612

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

19435 68TH Ave S Ste S102
Kent, WA 98032-2114

Mailing address

19435 68TH Ave S Ste S102
Kent, WA 98032-2114
Phone (253) 414-1983

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250227003423 WA Part B Supplier - Clinic/Group Practice 7618497033 Receives reassigned benefits from 9 practitioners
Practice locations: Kent, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1043021595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19435 68TH AVE S STE S102",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980322114",
            "telephone_number": "253-414-1983",
            "fax_number": "425-616-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19435 68TH AVE S STE S102",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980322114",
            "telephone_number": "253-414-1983",
            "fax_number": "425-616-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "HO",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "714-251-7612"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.