Jill Ellen Stack, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61593905 Issued in WA

Practice address

101 Elliott Ave W Ste 500
Seattle, WA 98119-4292

Phone

(808) 348-1472

NPI assigned

Aug 6, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

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.

• Counseling Services for Wellbeing, Inc.

  • Marriage & Family Therapist
  • Burien, WA
  • NPI 1588080626
  Medicare reassignment NPD
• Lightheart Associates PS

  • Psychologist
  • Redmond, WA
  • NPI 1609221720
  Medicare reassignment NPD
• Mindful Therapy Group PC

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

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Dr. Kathleen Worsley

  • Counseling Psychologist
  • Redmond, WA
  • NPI 1619484821
  NPD (past)

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729555200000",
    "number": "1215767975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 SW 118TH ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981462830",
            "telephone_number": "808-348-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 ELLIOTT AVE W STE 500",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981194292",
            "telephone_number": "808-348-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "JILL",
        "middle_name": "ELLEN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61593905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey E Prince PHD PS
• Stacey McFarland Licsw PLLC
• Andrew W Stacey, M.D.
• Brett Russell Stacey, M.D.
• Julie Stachowiak, RN
• Amy Stackhouse, RDN, CN
• Frank A Stackhouse, MD
• Jonathan Stackhouse, ARNP
• Sarah L Stacpoole, ARNP, DNP
• Brian J Stacy, CRNA

• Psychiatric/Mental Health Nurse Practitioner in Seattle, WA
• Providers in Seattle, 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 Oct 22, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.