Jessica Nicole Shine, PHD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

RC00054256 Issued in WA

Practice address

900 Sheridan Rd
Suite 106
Bremerton, WA 98310-2701

Phone

(360) 415-5866

Fax

(360) 415-5886

NPI assigned

Jan 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica Nicole Smith Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306990551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 ALMIRA DR SE",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983118330",
            "telephone_number": "360-373-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SHERIDAN RD",
            "address_2": "SUITE 106",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983102701",
            "telephone_number": "360-415-5866",
            "fax_number": "360-415-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHINE",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "RC00054256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SMITH",
            "middle_name": "NICOLE",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert Sheridan, PTA
• Dawa Sherpa
• Daniel Sherwood, MD
• Elizabeth Shifflett
• Chloe Shilts
• Jared J Shinkaruk, MA61459672
• Darcy Marie Shirley
• Judith Shoesmith, PTA
• Marshall Short
• Michael Gareth Shrouf, ARNP

• Mental Health Counselor in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.