Active NPI
Terry Elizabeth Douglass, ARNP, PHD
- Psychiatric/Mental Health Registered Nurse
- Bainbridge Island, WA
National Provider Identifier
1295728244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Registered Nurse
- License
- AP30000194
- Practice address
- 6863 Eagle Harbor Dr NE
Bainbridge Island, WA 98110-3103 - Phone
- (260) 660-6199
- Fax
- (206) 238-9777
- NPI assigned
- Aug 25, 2005
- Reactivated
- Apr 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatric/Mental Health Registered Nurse | 163WP0807X | AP30000194 | WA | |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | AP30000194 | WA | Primary |
Addresses
Primary practice location
6863 Eagle Harbor Dr NE
Bainbridge Island, WA 98110-3103
Mailing address
6863 Eagle Harbor Dr NE
Bainbridge Island, WA 98110-3103
Phone (206) 660-6199
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9605122 | Medicaid | WA |
Other names 1
- Dr. Theresse Elizabeth Douglass
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415923200000",
"number": "1295728244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6863 EAGLE HARBOR DR NE",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981103103",
"telephone_number": "206-660-6199",
"fax_number": "206-238-9777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6863 EAGLE HARBOR DR NE",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981103103",
"telephone_number": "260-660-6199",
"fax_number": "206-238-9777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLASS",
"first_name": "TERRY",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "ARNP, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-25",
"last_updated": "2014-11-14",
"deactivation_date": "2006-03-25",
"reactivation_date": "2006-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0807X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
"state": "WA",
"license": "AP30000194",
"primary": false
},
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "WA",
"license": "AP30000194",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9605122",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "THERESSE",
"last_name": "DOUGLASS",
"middle_name": "ELIZABETH",
"prefix": "DR.",
"credential": "ARNP, PHD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Bainbridge Island, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.