Jaqueline Carrasco, MA-C

Key facts

NPI

1265077903

Entity type

Individual (NPI type 1)

Primary specialty

Nurse's Aide 376K00000X

License

CM60504139 (WA)

Practice address

2700 Simpson Ave Ste 101
Aberdeen, WA 98520-4333

Phone

(360) 612-0012

Fax

(360) 532-0670

NPI assigned

Nov 15, 2019

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Columbia Wellness Case Management Agency · Longview, WA · NPI 1487659579
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Jaqueline Cano Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 15, 2019.

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1265077903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1847",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328140",
            "telephone_number": "360-353-9828",
            "fax_number": "360-577-0269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 SIMPSON AVE STE 101",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985204333",
            "telephone_number": "360-612-0012",
            "fax_number": "360-532-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASCO",
        "first_name": "JAQUELINE",
        "credential": "MA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "WA",
            "license": "CM60504139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA LICENSE",
            "identifier": "CM60504139",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAQUELINE",
            "last_name": "CANO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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All providers in Aberdeen, WA · Nurse's Aide in Washington