Jackline Monyangi Moriasi, MSN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

10108 Issued in MN

Practice address

6200 Shingle Creek Pkwy Ste 350
Brooklyn Center, MN 55430-2155

Phone

(763) 503-8560

Fax

(763) 503-8563

NPI assigned

Sep 20, 2022

Last updated

Jun 22, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jackline Monyangi Raini Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Morriset Homecare LLC

  • Home Health Agency
  • Brooklyn Center, MN
  • NPI 1093576332
  NPD Authorized official
• Lyn-Lake Psychotherapy and Wellness LTD.

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1609355163
  Medicare reassignment

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1326761842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4240 PARK GLEN RD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554165427",
            "telephone_number": "612-925-6033",
            "fax_number": "612-925-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY STE 350",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302155",
            "telephone_number": "763-503-8560",
            "fax_number": "763-503-8563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORIASI",
        "first_name": "JACKLINE",
        "middle_name": "MONYANGI",
        "credential": "MSN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-20",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "10108",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN312890",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "1699478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKLINE",
            "last_name": "RAINI",
            "middle_name": "MONYANGI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nadezhda Montik
• Quentin Moore
• Celeste Essie Morales
• Badr Morchid
• Maryanne M Moren, MD
• Shleana Lervenda Morris
• Morriset Homecare LLC
• Alicia Rosa Morrow Tellez Giron
• Brian M Morseth
• Alyssa Moua, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.