Individual provider Active NPI

Jennifer Rousseau, ARNP

  • Nurse Practitioner
  • Puyallup, WA
National Provider Identifier
1093608275
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP6168965 Issued in WA
Practice address
611 31St Ave SW
Puyallup, WA 98373-3723
Phone
(253) 848-5951
Fax
(253) 845-7073
NPI assigned
May 29, 2025
Last updated
May 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2025

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 AP6168965 WA Primary

Addresses

Primary practice location

611 31St Ave SW
Puyallup, WA 98373-3723

Mailing address

3908 10TH St SE
Puyallup, WA 98374-2188
Phone (253) 848-5951

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
I20250612002978 WA Practitioner - Nurse Practitioner 7911418447 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Hill Family Medicine PCGroup PAC ID 8729980396, 67 clinicians

Practice addresses (Care Compare)

611 31St Ave SW
Suite C
Puyallup, WA 98373-3723
Phone (253) 848-5951

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP6168965WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Hill Family Medicine PC CurrentSince Jul 1, 2025 Accepting new patients
Kaiser Foundation Health Plan of Washington PastSince Jun 3, 2025 Accepting new patients

Locations

3908 10th St SE
Puyallup, WA 98374
Phone (253) 848-5951

611 31st Ave SW
Ste C
Puyallup, WA 98373
Phone (253) 848-5951

Interoperability endpoints

  • Direct secure messaging: jrousseau98687@direct.tecmc.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1748476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1093608275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 10TH ST SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983742188",
            "telephone_number": "253-848-5951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 31ST AVE SW",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733723",
            "telephone_number": "253-848-5951",
            "fax_number": "253-845-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSEAU",
        "first_name": "JENNIFER",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-29",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP6168965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.