Individual provider Active NPI

Keillan Leigh Mennella, ARNP

  • Family Nurse Practitioner
  • Seattle, WA
National Provider Identifier
1255840559
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60793473 Issued in WA
Practice address
4915 25TH Ave NE Ste 300W
Seattle, WA 98105-5668
Phone
(206) 520-5000
NPI assigned
Sep 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP60793473 WA
Family Nurse Practitioner 363LF0000X AP60793473 WA Primary

Addresses

Primary practice location

4915 25TH Ave NE Ste 300W
Seattle, WA 98105-5668

Mailing address

PO Box 50095
Seattle, WA 98145-5095
Phone (206) 520-5700

Other identifiers 1

IdentifierTypeStateIssuer
1255840559MedicaidWA

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
I20171219001063 WA Practitioner - Nurse Practitioner 4082972179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Association of University PhysiciansGroup PAC ID 0446162697, 3,484 clinicians

Practice addresses (Care Compare)

4915 25TH Ave NE 300
Uwnc Ravenna Clinic
Seattle, WA 98105-5668
Phone (206) 525-7777

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as apm
Quality
74.6
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP60793473WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Association of University Physicians CurrentSince Sep 28, 2022 Accepting new patients
Stillaguamish Tribal Health Clinic PastSince Jun 18, 2023 Accepting new patients

Locations

4915 25th Ave NE
Ste 300
Seattle, WA 98105
Phone (206) 525-7777

1959 NE Pacific St
Seattle, WA 98195
Phone (206) 598-4333

4915 25th Ave NE
Ste 300W
Seattle, WA 98105
Phone (206) 520-1606

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: keillan.mennella@70976835354628.direct.elationemr.com
  • Direct secure messaging: kmennella383484@direct.ehre.uwmedicine.org

Organizations & group practices 2

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": "1506643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1255840559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-520-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 25TH AVE NE STE 300W",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981055668",
            "telephone_number": "206-520-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENNELLA",
        "first_name": "KEILLAN",
        "middle_name": "LEIGH",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-29",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60793473",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60793473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255840559",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.