Individual provider Active NPI

Nichole Rodriguez, ARNP

  • Family Nurse Practitioner
  • Kennewick, WA
National Provider Identifier
1063193746
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61465286 Issued in WA
Practice address
1350 N Grant St
Kennewick, WA 99336-1355
Phone
(509) 783-5465
Fax
(509) 735-3980
NPI assigned
Jul 26, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP61465286 WA Primary

Addresses

Primary practice location

1350 N Grant St
Kennewick, WA 99336-1355

Mailing address

1350 N Grant St
Kennewick, WA 99336-1355
Phone (509) 783-5465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20230911004176 WA Practitioner - Nurse Practitioner 3476917386 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
Group practices
Center for Functional Health PLLCGroup PAC ID 7012396674, 3 clinicians

Practice addresses (Care Compare)

1350 N Grant St
Kennewick, WA 99336-1355
Phone (509) 735-2014

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61465286WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Functional Health PLLC CurrentSince Aug 1, 2023 Accepting new patients

Locations

1350 N Grant St
Kennewick, WA 99336
Phone (509) 735-2014

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 1

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": "1690329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1063193746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 N GRANT ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993361355",
            "telephone_number": "509-783-5465",
            "fax_number": "509-735-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N GRANT ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993361355",
            "telephone_number": "509-783-5465",
            "fax_number": "509-735-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "NICHOLE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-26",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61465286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

Verify at the official NPI Registry.