Individual provider Active NPI

Jamie Laird Waldera, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Winona, MN
National Provider Identifier
1043095649
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
10728 Issued in MN
Practice address
855 Mankato Ave
Winona, MN 55987-4868
Phone
(597) 457-4484
NPI assigned
Aug 30, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 10728 MN Primary

Addresses

Primary practice location

855 Mankato Ave
Winona, MN 55987-4868

Mailing address

2504 Hass St
La Crosse, WI 54601-7624
Phone (608) 385-7504

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20231027003165 MN Practitioner - Nurse Practitioner 3173979028 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Winona Health ServicesGroup PAC ID 8527977420, 160 clinicians

Practice addresses (Care Compare)

855 Mankato Ave
Winona, MN 55987-4868
Phone (507) 454-3650

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10728MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Winona Health Services CurrentSince Sep 18, 2023 Accepting new patients

Locations

855 Mankato Ave
Winona, MN 55987
Phone (507) 454-3680

Organizations & group practices 1

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

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1043095649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 HASS ST",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546017624",
            "telephone_number": "608-385-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 MANKATO AVE",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559874868",
            "telephone_number": "597-457-4484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDERA",
        "first_name": "JAMIE",
        "middle_name": "LAIRD",
        "credential": "APRN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "10728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

Verify at the official NPI Registry.