Fonabei Ayongaba

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61475276 Issued in WA

Practice address

605 Woodland Square Loop SE
Lacey, WA 98503-1045

Phone

(844) 949-8888

NPI assigned

Jan 25, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Vest Thurston LLCGroup PAC ID 0648512459, 14 clinicians

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Mindful Therapy Group PC

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  Psychiatric/Mental Health, WA

  Medicare reassignment Care Compare group NPD
• Vest Thurston LLC

  • Psychiatric Hospital
  • Lacey, WA
  • NPI 1336605849

  WA

  Medicare reassignment Care Compare group NPD
• Telecare Mental Health Services of Washington, Inc

  • Psychiatric Residential Treatment Facility
  • Tacoma, WA
  • NPI 1780913657

  WA

  Medicare reassignment NPD
• Telecare Mental Health Services of Washington Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tukwila, WA
  • NPI 1902540362
  NPD
• Telecare Mental Health Services of Washington, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vancouver, WA
  • NPI 1699162925
  NPD

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1104532944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 W GOWE ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980325892",
            "telephone_number": "253-833-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WOODLAND SQUARE LOOP SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031045",
            "telephone_number": "844-949-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYONGABA",
        "first_name": "FONABEI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-09-06",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN61094794",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61475276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramzy Assaf
• Dean Atkins, LMT
• Jennifer Austin
• Yvonne Austin
• Oscar R Ayala
• Emily Baca
• Back on Track Chiropractic and Massage, LLC
• Laurel Andvik Backstrom, P.T.
• Dalyn Badis
• Ana Bailey, M.ED. BCBA

• Psychiatric/Mental Health Nurse Practitioner in Lacey, WA
• Providers in Lacey, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.