Jacqueline Wahl

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP61073449 Issued in WA

Practice address

2901 174TH St NE
Marysville, WA 98271-4743

Phone

(360) 454-1900

NPI assigned

Jun 16, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA, OR2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optum Care Washington PLLCGroup PAC ID 6406752153, 684 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3889/brand/1/csg/1/fhir/r4
• Direct secure messaging: jwahl124176@wm.providencedirect.org
• Direct secure messaging: jwahl109424@westdirect.optum.com
• Direct secure messaging: jwahl12795@direct.tecmc.com

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.

• Optum Care Washington PLLC

  • Multi-Specialty Clinic/Center
  • Everett, WA
  • NPI 1831186766
  Medicare reassignment Care Compare group
• The Polyclinic PLLC

  dba Optum - Broadway

  • Audiologist
  • Seattle, WA
  • NPI 1174594634
  Medicare reassignment NPD
• Oregon Healthcare Resources, LLC

  dba Oregon Medical Group

  • Multi-Specialty Clinic/Center
  • Eugene, OR
  • NPI 1982907572
  Medicare reassignment NPD
• Optum Care Washington PLLC

  • Ambulatory Surgical Clinic/Center
  • Arlington, WA
  • NPI 1366154304
  NPD
• The Polyclinic

  • Ambulatory Surgical Clinic/Center
  • Seattle, WA
  • NPI 1073944039
  NPD
• The Polyclinic PLLC

  dba Optum Tacoma

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1831411487
  NPD
• Optum Care Washington PLLC

  • Ambulatory Surgical Clinic/Center
  • Everett, WA
  • NPI 1154318103
  NPD (past)
• The Polyclinic PLLC

  dba Optum Care Washington

  • Durable Medical Equipment & Medical Supplies
  • Seattle, WA
  • NPI 1346620200
  NPD (past)

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1437774338",
    "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": "360-454-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 174TH ST NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982714743",
            "telephone_number": "360-454-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2830 Crescent Ave",
            "address_purpose": "LOCATION",
            "city": "Eugene",
            "state": "OR",
            "postal_code": "974087397",
            "country_code": "US",
            "telephone_number": "541-686-9000",
            "fax_number": "541-242-4585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHL",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61073449",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OR",
            "license": "10022236",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwahl124176@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "500 W Broadway St",
            "city": "Missoula",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598024008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cathy Vu
• Quang Thanh Vu, PHARM.D.
• Lisa M. Vuk, PT
• Christine Thuy Wagner, RN
• Jennifer A Wagner, MD
• Sara Elizabeth Wainwright, DC
• Wal-Mart Stores, Inc (Vision Center 30-2595)
• Wal-Mart Stores, Inc (Wal-Mart Pharmacy 30-3801)
• Walgreen Co (Walgreens #15158)
• Amber N Walker, M. P.T.

• Nurse Practitioner in Marysville, WA
• Providers in Marysville, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.