Individual provider Active NPI

Lauren Keanna Jensen

  • Psychiatric/Mental Health Nurse Practitioner
  • Mill Creek, WA
National Provider Identifier
1336786649
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP61307230 Issued in WA
Practice address
15418 Main St
Mill Creek, WA 98012-9030
Phone
(425) 339-5453
Fax
(425) 252-4441
NPI assigned
Dec 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X RN60951576 WA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61307230 WA Primary

Addresses

Primary practice location

15418 Main St
Mill Creek, WA 98012-9030

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 304-8431

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230322000163 WA Practitioner - Nurse Practitioner 2668846221 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN60951576WAMDEmergency Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
The Polyclinic PLLC CurrentSince Dec 8, 2022 Accepting new patients
The Polyclinic CurrentSince Dec 8, 2022 Accepting new patients
The Polyclinic PLLC Current Accepting new patients
Optum Care Washington PLLC CurrentSince Dec 17, 2022 Accepting new patients
Optum Care Washington PLLC CurrentSince Dec 17, 2022 Accepting new patients

Locations

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

15418 Main St
Mill Creek, WA 98012
Phone (425) 225-8000

1145 Broadway
Seattle, WA 98122

904 7th Ave
Seattle, WA 98104
Phone (206) 223-6487

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

Interoperability endpoints

  • Direct secure messaging: ljensen68918@direct.tecmc.com

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668124800000",
    "number": "1336786649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-304-8431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15418 MAIN ST",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980129030",
            "telephone_number": "425-339-5453",
            "fax_number": "425-252-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "LAUREN",
        "middle_name": "KEANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-05",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "WA",
            "license": "RN60951576",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61307230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Creek, WA

Sources for this page

Verify at the official NPI Registry.