Organization Active NPI

Maple Valley Movement Neurology, PLLC

  • Neurology Physician
  • Maple Valley, WA
National Provider Identifier
1265150379
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
MAPLE VALLEY MOVEMENT NEUROLOGY, PLLC
Practice address
22620 SE 216TH PL Ste E
Maple Valley, WA 98038-6327
Phone
(425) 200-4546
Fax
(425) 523-9167
NPI assigned
Aug 16, 2022
Last updated
May 18, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Dr. Jennifer Lelia Davis, DONPI 1831485846
Title
Auth Official
Phone
(425) 200-4546

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X NU Primary

Addresses

Primary practice location

22620 SE 216TH PL Ste E
Maple Valley, WA 98038-6327

Mailing address

27317 Maple Valley Black Diamond Rd SE Ste A110
Maple Valley, WA 98038-5158
Phone (425) 200-4546

Other practice location 1

27317 Maple Valley Black Diamond Rd SE Ste A110
Maple Valley, WA 98038-5158
Phone (425) 200-4546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221101003024 WA Part B Supplier - Clinic/Group Practice 4789051947 Receives reassigned benefits from 2 practitioners
Practice locations: Maple Valley, WA

National Provider Directory

National Provider Directory

Locations

22620 SE 216th Pl
Ste D
Maple Valley, WA 98038

22620 SE 216th Pl
Ste E
Maple Valley, WA 98038
Phone (425) 200-4546

27317 Black Diamond Rd SE
Ste A110
Maple Valley, WA 98038
Phone (425) 200-4546

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EEIICD

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1660608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1265150379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27317 MAPLE VALLEY BLACK DIAMOND RD SE STE A110",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980385158",
            "telephone_number": "425-200-4546",
            "fax_number": "425-523-9167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22620 SE 216TH PL STE E",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386327",
            "telephone_number": "425-200-4546",
            "fax_number": "425-523-9167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27317 Maple Valley Black Diamond Rd SE Ste A110",
            "address_purpose": "LOCATION",
            "city": "Maple Valley",
            "state": "WA",
            "postal_code": "980385158",
            "country_code": "US",
            "telephone_number": "425-200-4546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAPLE VALLEY MOVEMENT NEUROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-16",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LELIA",
        "authorized_official_title_or_position": "AUTH OFFICIAL",
        "authorized_official_telephone_number": "425-200-4546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.