Jennifer Douglas, RN00123804

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60427024 Issued in WA

Practice address

1520 Kelly PL Ste 220
Walla Walla, WA 99362-8607

Phone

(509) 520-2924

NPI assigned

Jan 3, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Jennifer Douglas Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1357171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389744000000",
    "number": "1235476706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1595",
            "address_2": "1520 KELLY PLACE, SUITE 220",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993620329",
            "telephone_number": "509-520-2924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 KELLY PL STE 220",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993628607",
            "telephone_number": "509-520-2924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JENNIFER",
        "name_prefix": "Ms.",
        "credential": "RN00123804",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-03",
        "last_updated": "2014-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "WA",
            "license": "RN00123804",
            "primary": false
        },
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "WA",
            "license": "RN00123804",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60427024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DOUGLAS",
            "prefix": "MS.",
            "credential": "AP60427024",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gregory David Done, MA, DSOM
• Hayla Donovan
• Daniel James Doran, MD
• Eugene Joseph Dotolo, LICSW
• Jessica Dougherty-Burt
• Dr. Richard J. Sundberg D.D.S., P.S.
• Lindsay Anne Drango
• Heidi Drennen
• Jason Adam Dreyer, DO
• Keeley C Drotz, RDN (REGISTERED DIET

• Psychiatric/Mental Health Nurse Practitioner in Walla Walla, WA
• Providers in Walla Walla, 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 Jan 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.