NPIMap

Organization Active NPI

Faith Home Care Practitioners, PLLC

  • Family Nurse Practitioner
  • Chehalis, WA
National Provider Identifier
1275917254
Registry record updated Jul 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60396765 Issued in WA
Legal business name
FAITH HOME CARE PRACTITIONERS, PLLC
Practice address
34 NE Boistfort St
Ste. 124
Chehalis, WA 98532-2600
Phone
(360) 996-4443
Fax
(360) 242-0049
NPI assigned
Jul 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2015

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

Authorized official

Name
Julie Calderon, ARNPNPI 1700228152
Title
Owner
Phone
(360) 996-4443

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
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X AP60396765 WA Primary

Addresses

Primary practice location

34 NE Boistfort St
Ste. 124
Chehalis, WA 98532-2600

Mailing address

34 NE Boistfort St
Ste. 124
Chehalis, WA 98532-2600
Phone (360) 996-4443

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150924000149 WA Part B Supplier - Clinic/Group Practice 8426365412 Receives reassigned benefits from 3 practitioners
Practice locations: Chehalis, WA

National Provider Directory

National Provider Directory

Locations

34 NE Boistfort St
Ste 124
Chehalis, WA 98532
Phone (360) 996-4443

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437350400000",
    "number": "1275917254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 NE BOISTFORT ST",
            "address_2": "STE. 124",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322600",
            "telephone_number": "360-996-4443",
            "fax_number": "360-242-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 NE BOISTFORT ST",
            "address_2": "STE. 124",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322600",
            "telephone_number": "360-996-4443",
            "fax_number": "360-242-0049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH HOME CARE PRACTITIONERS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-20",
        "last_updated": "2015-07-20",
        "status": "A",
        "authorized_official_last_name": "CALDERON",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-996-4443",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60396765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chehalis, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; 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.