Active NPI
Jay R Skidmore, PH.D.
- Clinical Psychologist
- Everett, WA
National Provider Identifier
1043664352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00002488
- Practice address
- 2230 Rucker Ave Ste 100
Everett, WA 98201-2772 - Phone
- (206) 200-4357
- NPI assigned
- Apr 22, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00002488 | WA | Primary |
Addresses
Primary practice location
2230 Rucker Ave Ste 100
Everett, WA 98201-2772
Mailing address
15121 62ND Ave W
Edmonds, WA 98026-4105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00002488 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461283200000",
"number": "1043664352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15121 62ND AVE W",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980264105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2230 RUCKER AVE STE 100",
"city": "EVERETT",
"state": "WA",
"postal_code": "982012772",
"telephone_number": "206-200-4357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKIDMORE",
"first_name": "JAY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-22",
"last_updated": "2016-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00002488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.