Individual provider Active NPI

Nichole Adrianne Bosma, FNP-C

  • Nurse Practitioner
  • Yakima, WA
National Provider Identifier
1396516761
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP61521891 Issued in WA
Practice address
504 N 40TH Ave
Yakima, WA 98908-4311
Phone
(509) 966-9480
NPI assigned
Jan 12, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN60174063 WA
Family Medicine Physician 207Q00000X MB8644583 WA
Family Medicine Physician 207Q00000X AP61521891 WA
Family Medicine Physician 207Q00000X F01240502 WA
Nurse Practitioner 363L00000X AP61521891 WA Primary

Addresses

Primary practice location

504 N 40TH Ave
Yakima, WA 98908-4311

Mailing address

504 N 40TH Ave
Yakima, WA 98908-4311
Phone (509) 966-9480

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
I20240419000930 WA Practitioner - Nurse Practitioner 2264871565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians

Practice addresses (Care Compare)

504 N 40TH Ave
Yakima, WA 98908-4311
Phone (509) 966-9480

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61521891WAMDFamily Medicine Physician
F01240502WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yakima Valley Memorial Physicians Current Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Apr 29, 2024 Accepting new patients
Yakima Valley Memorial Physicians CurrentSince Apr 29, 2024 Accepting new patients

Locations

504 N 40th Ave
Yakima, WA 98908

2811 Tieton Dr
Yakima, WA 98902
Phone (509) 249-5210

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1396516761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 N 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989084311",
            "telephone_number": "509-966-9480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 N 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989084311",
            "telephone_number": "509-966-9480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSMA",
        "first_name": "NICHOLE",
        "middle_name": "ADRIANNE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60174063",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MB8644583",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "AP61521891",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "F01240502",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61521891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

Verify at the official NPI Registry.