Individual provider Active NPI

Julie A Dewitt-Kamada, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Vancouver, WA
National Provider Identifier
1073572269
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP30006697 Issued in WA
Practice address
3208 NE 141St St
Vancouver, WA 98686-2260
Phone
(503) 869-0804
Fax
(360) 852-9074
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 096006634N6 OR
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP30006697 WA Primary

Addresses

Primary practice location

3208 NE 141St St
Vancouver, WA 98686-2260

Mailing address

3208 NE 141St St
Vancouver, WA 98686-2260
Phone (503) 869-0804

Other identifiers 1

IdentifierTypeStateIssuer
000279MedicaidOR

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
096006634N6ORMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317859200000",
    "number": "1073572269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 NE 141ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862260",
            "telephone_number": "503-869-0804",
            "fax_number": "360-852-9074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 NE 141ST ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986862260",
            "telephone_number": "503-869-0804",
            "fax_number": "360-852-9074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWITT-KAMADA",
        "first_name": "JULIE",
        "middle_name": "A",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2011-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "096006634N6",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP30006697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000279",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.