Jaime Mellor Vantine, FNP-C
Individual provider Active NPI Nurse Practitioner · Colfax, WA
NPI 1073799375 · NPPES record last updated Aug 13, 2019
Key facts
- NPI
- 1073799375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- AP60393668 (WA)
- Practice address
- 1210 W Fairview St
Colfax, WA 99111-9552 - Phone
- (509) 397-4717
- Fax
- (509) 397-3501
- NPI assigned
- Jan 16, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- College of Medicine and Surgery, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Public Hospital District No 3 of Whitman County
Practice addresses (Care Compare)
1200 W Fairview St
Colfax, WA 99111-9552
Phone (509) 397-3435
Hospital & facility affiliations
- Centerwell Home Health
- Whitman Hospital and Medical Center
- Pullman Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130724000957 | WA | Practitioner - Nurse Practitioner | 1850475591 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Public Hospital District No 3 of Whitman County | Current |
Accepting new patients | |
| St. Mary'S Regional Medical Center | Past | Accepting new patients | |
| St. Mary'S Regional Medical Center | Past | Accepting new patients |
Locations
1210 W Fairview St
Colfax, WA 99111
Phone (509) 397-4717
1200 W Fairview St
Colfax, WA 99111
Phone (509) 397-3435
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP60393668 | WA | Yes |
Addresses
Primary practice location
1210 W Fairview St
Colfax, WA 99111-9552
Mailing address
1210 W Fairview St
Colfax, WA 99111-9552
Phone (509) 397-4717
Other names
- Jaime Mellor Roche
NPI Registry JSON
{
"created_epoch": "1200441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565654400000",
"number": "1073799375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 W FAIRVIEW ST",
"city": "COLFAX",
"state": "WA",
"postal_code": "991119552",
"telephone_number": "509-397-4717",
"fax_number": "509-397-3501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 W FAIRVIEW ST",
"city": "COLFAX",
"state": "WA",
"postal_code": "991119552",
"telephone_number": "509-397-4717",
"fax_number": "509-397-3501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANTINE",
"first_name": "JAIME",
"middle_name": "MELLOR",
"name_prefix": "Mrs.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-16",
"last_updated": "2019-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP60393668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JAIME",
"last_name": "ROCHE",
"middle_name": "MELLOR",
"credential": "FNP-C",
"code": "1",
"type": "Former Name"
}
]
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.