Active NPI
Mary R Chmelik, ARNP
- Pediatric Nurse Practitioner
- Tacoma, WA
National Provider Identifier
1194743757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- AP 30005436
- Practice address
- 311 S L St
Tacoma, WA 98405-3720 - Phone
- (253) 403-1449
- NPI assigned
- Jul 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | AP 30005436 | WA | Primary |
| Nurse Practitioner | 363L00000X | AP30005436 | WA | |
| Family Nurse Practitioner | 363LF0000X | AP30005436 | WA |
Addresses
Primary practice location
311 S L St
Tacoma, WA 98405-3720
Mailing address
311 S L St
Tacoma, WA 98405-3720
Phone (253) 403-1449
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP 30005436 | Other | WA | PROFESSIONAL LICENSE |
| 9625179 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP30005436 | WA | MD | Nurse Practitioner |
| AP 30005436 | WA | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1194743757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 S L ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984053720",
"telephone_number": "253-403-1449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 S L ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984053720",
"telephone_number": "253-403-1449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHMELIK",
"first_name": "MARY",
"middle_name": "R",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "WA",
"license": "AP 30005436",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WA",
"license": "AP30005436",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP30005436",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "AP 30005436",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9625179",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.