Jennifer Russo, RN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

202203390-NP-PP Issued in OR

Practice address

2480 E Tompkins Ave Ste 100
Las Vegas, NV 89121-7394

Phone

(725) 724-2005

Fax

(877) 418-8013

NPI assigned

Apr 15, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Henderson Psychiatry CorporationGroup PAC ID 4880037886, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Henderson Psychiatry Corporation

  • Psychiatric/Mental Health Nurse Practitioner
  • Henderson, NV
  • NPI 1235906330
  Medicare reassignment Care Compare group NPD
• The Vice Practice LLC

  • Family Nurse Practitioner
  • Las Vegas, NV
  • NPI 1790465698
  Medicare reassignment NPD
• Changing Minds Psychiatry LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Las Vegas, NV
  • NPI 1821537242
  Medicare reassignment
• TVP Behavioral Health LLC

  • Counselor
  • Las Vegas, NV
  • NPI 1902623713
  NPD
• Changing Minds Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Las Vegas, NV
  • NPI 1760993117
  NPD (past)

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

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1407200413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 KIND AVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890023364",
            "telephone_number": "702-824-7691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 E TOMPKINS AVE STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891217394",
            "telephone_number": "725-724-2005",
            "fax_number": "877-418-8013"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "83 Kind Ave",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890023364",
            "country_code": "US",
            "telephone_number": "702-824-7691",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSO",
        "first_name": "JENNIFER",
        "credential": "RN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NV",
            "license": "RN55131",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G167246",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "238538",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NV",
            "license": "848206",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202203390-NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lynn Russian, APRN
• Lanyne Joelle Russie
• Ann Russo
• Christina Russo, LMSW, CSW-INTERN
• Giuseppe Charles Russo, PRSS-INTERN
• Jessica Colleen Russo
• Richard Angelo Russo
• Simone Frank Russo
• Lauren Mishel Russum Wesley
• Amanda Rust

• Psychiatric/Mental Health Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychiatric/Mental Health Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.