Jacqueline Clubine, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

AP61546588 Issued in WA

Practice address

433 E 8TH St
Port Angeles, WA 98362-6219

Phone

(360) 565-0999

NPI assigned

Feb 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, WA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jclubine169605@directwellstar.org

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.

• Olympic Medical Physicians

  • Family Medicine Physician
  • Port Angeles, WA
  • NPI 1427081967
  Medicare reassignment NPD
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Stone Mountain, GA
  • NPI 1417011487
  Medicare reassignment NPD
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1811761448
  NPD
• Clallam County Public Hospital District 2

  • General Acute Care Hospital
  • Port Angeles, WA
  • NPI 1306845557
  NPD (past)
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1225573025
  NPD (past)

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1053812362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983620146",
            "telephone_number": "360-565-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 E 8TH ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626219",
            "telephone_number": "360-565-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLUBINE",
        "first_name": "JACQUELINE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "RN261851",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WA",
            "license": "AP61546588",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61546589",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tasha Clark, RN
• Denise Elizabeth Clarke, MSED DMD
• Bunny Claxton
• Clinicare of Port Angeles Inc
• Adam Cloutier
• Michael Matthew Coffey, L.D.
• Beckett Teal Cohen, DC, MS
• Kirk A Cole, MD
• Glenda Jeannette Coleman, CDP
• Collaborative Counseling LLC

• Advanced Practice Midwife in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Advanced Practice Midwife in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.