Gareth John Penta, DNP, ARNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

ARNP.AP.61079484-NP Issued in WA

Practice address

880 11TH Ave Ste 201
Longview, WA 98632-2402

Phone

(360) 559-3456

NPI assigned

Jun 5, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1376167254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 11TH AVE STE 201",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 11TH AVE STE 201",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322402",
            "telephone_number": "360-559-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENTA",
        "first_name": "GARETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DNP, ARNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-05",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "ARNP.AP.61079484-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "garethpenta@well-thought.drchronodirect.com",
            "affiliation": "N",
            "address_1": "880 11th Ave Ste 201",
            "city": "Longview",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986322402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pediatric Clinic, Inc., P.S.
• Kortnie Victoria Pena
• Angela Diane Pence, MSW, LICSW, DMHP
• Austyn Pence
• Gary Elliot Penner, MD
• Vivian M Peralta Mesa, MS, LMFT
• Karl Evert Pereira, COTA/L
• Jill Ann Pergiel
• Mindy K Perkins, BA, AAC
• Rachel Lynette Perry, CDP

• Psychiatric/Mental Health Nurse Practitioner in Longview, WA
• Providers in Longview, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.