Organization Active NPI

Hippy Gangster PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lynnwood, WA
National Provider Identifier
1093601064
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
HIPPY GANGSTER PLLC
Practice address
19888 40TH Ave W Apt 625
Lynnwood, WA 98036-6794
Phone
(425) 377-4301
NPI assigned
Jun 16, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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

Authorized official

Name
Monica Nicole PrederNPI 1700662111
Title
Ceo
Phone
(425) 377-4301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

19888 40TH Ave W Apt 625
Lynnwood, WA 98036-6794

Mailing address

19888 40TH Ave W Apt 625
Lynnwood, WA 98036-6794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260325004001 WA Part B Supplier - Clinic/Group Practice 5890270003 Receives reassigned benefits from 1 practitioner
Practice locations: Lynnwood, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1093601064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19888 40TH AVE W APT 625",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19888 40TH AVE W APT 625",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366794",
            "telephone_number": "425-377-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIPPY GANGSTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-16",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "PREDER",
        "authorized_official_first_name": "MONICA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-377-4301"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.