Jesse Headapohl Fatoma

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

326908 Issued in AZ

Practice address

11770 W Davis LN
Avondale, AZ 85323-7695

Phone

(480) 217-8964

NPI assigned

Jun 19, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Jangay Psychiatric Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Avondale, AZ
  • NPI 1609719657
  NPD Authorized official
• Connectionsaz, LLC

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1083840953
  Medicare reassignment
• NGC Integrated Healthcare

  • Mental Health Counselor
  • Tolleson, AZ
  • NPI 1700478740
  NPD (past)

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

{
    "created_epoch": "1750291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1407743891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11770 W DAVIS LN",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853237695",
            "telephone_number": "480-217-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11770 W DAVIS LN",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853237695",
            "telephone_number": "480-217-8964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11770 W Davis Ln",
            "address_purpose": "LOCATION",
            "city": "Avondale",
            "state": "AZ",
            "postal_code": "853237695",
            "country_code": "US",
            "telephone_number": "480-217-8964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FATOMA",
        "first_name": "JESSE",
        "middle_name": "HEADAPOHL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-19",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "326908",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "RN204116",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Farmer
• Diane Farnsworth
• Anthony Farrell
• Farzin Allameh DDS PC of Avondale
• Fast Ride LLC
• Fenix Group, LLC
• Alyssa Fernandez, DTP
• Christopher R Fernandez
• Jasmine Azucena Fernandez
• Michelle Fernandez

• Psychiatric/Mental Health Nurse Practitioner in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; 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.