Individual provider Active NPI

Michael Nduati Mugo, CRNP- PMH

  • Psychiatric/Mental Health Nurse Practitioner
  • Federal Way, WA
National Provider Identifier
1124710066
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP61477252 Issued in WA
Practice address
33455 6TH Ave S Ste 2C
Federal Way, WA 98003-6074
Phone
(253) 367-0502
NPI assigned
May 22, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X R164946 MD
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61477252 WA Primary

Addresses

Primary practice location

33455 6TH Ave S Ste 2C
Federal Way, WA 98003-6074

Mailing address

9715 Davison Rd
Middle River, MD 21220-3884
Phone (443) 835-8678

Other practice location 1

9715 Davison Rd
Middle River, MD 21220-3884
Phone (443) 835-8678

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
I20240510002771 WA Practitioner - Nurse Practitioner 5991146722 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R164946MDMDPsychiatric/Mental Health Nurse Practitioner
AP61477252WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lightheart Associates PS CurrentSince Apr 1, 2024 Accepting new patients
Telecare Mental Health Services of Washington, Inc. CurrentSince Feb 1, 2026 Accepting new patients
Blu Orchard Therapy of Washington CurrentSince Sep 1, 2025 Accepting new patients
Telecare Mental Health Services of Washington Inc CurrentSince Feb 1, 2026 Accepting new patients
Dr. Kathleen Worsley PastSince Apr 1, 2024 Accepting new patients

Locations

33455 6th Ave S
Ste 2C
Federal Way, WA 98003
Phone (253) 210-4230

1800 Cooper Point Rd SW
Ste 22
Olympia, WA 98502
Phone (561) 201-9281

7902 168th Ave NE
Ste 101
Redmond, WA 98052
Phone (425) 472-2681

307 W Cota St
Shelton, WA 98584
Phone (360) 205-8001

Organizations & group practices 6

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": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1124710066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9715 DAVISON RD",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212203884",
            "telephone_number": "443-835-8678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33455 6TH AVE S STE 2C",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980036074",
            "telephone_number": "253-367-0502"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9715 Davison Rd",
            "address_purpose": "LOCATION",
            "city": "Middle River",
            "state": "MD",
            "postal_code": "212203884",
            "country_code": "US",
            "telephone_number": "443-835-8678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUGO",
        "first_name": "MICHAEL",
        "middle_name": "NDUATI",
        "credential": "CRNP- PMH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-22",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R164946",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61477252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.