Individual provider Active NPI

Jennifer Lynn Nicholas, FNP

  • Nurse Practitioner
  • Clarkston, WA
National Provider Identifier
1083978837
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP.AP.60299874-NP Issued in WA
Practice address
1433 5TH St
Clarkston, WA 99403-2714
Phone
(509) 758-5141
Fax
(509) 758-5299
NPI assigned
Jun 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP.AP.60299874-NP WA Primary

Addresses

Primary practice location

1433 5TH St
Clarkston, WA 99403-2714

Mailing address

4700 Exchange CT Ste 110
Boca Raton, FL 33431-4450
Phone (561) 948-0291

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
I20120807000749 WA Practitioner - Nurse Practitioner 3971759986 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Dermatology of Clarkston PLLCGroup PAC ID 5597102335, 6 clinicians

Practice addresses (Care Compare)

1250 SE Bishop Blvd
Suite F
Pullman, WA 99163-5449
Phone (509) 758-5141

Merit-based Incentive Payment System (MIPS)

Final score
89.65 of 100Reported as group
Quality
79.3
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Dermatology of Clarkston PLLC CurrentSince Jan 8, 2024 Accepting new patients

Locations

4700 Exchange Ct
Ste 110
Boca Raton, FL 33431
Phone (561) 223-8081

1433 5th St
#C
Clarkston, WA 99403
Phone (509) 758-5141

1433 5th St
Clarkston, WA 99403
Phone (509) 758-5141

1250 SE Bishop Blvd
Ste F
Pullman, WA 99163
Phone (509) 332-7424

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785715200000",
    "number": "1083978837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-948-0291",
            "fax_number": "561-859-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 5TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032714",
            "telephone_number": "509-758-5141",
            "fax_number": "509-758-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-26",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "ARNP.AP.60299874-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkston, WA

Sources for this page

Verify at the official NPI Registry.