NPIMap

Organization Active NPI

Port of Angels Pediatrics, PC

Doing business as Port of Angels Pediatrics

  • Pediatric Nurse Practitioner
  • Port Angeles, WA
National Provider Identifier
1487186888
Registry record updated Apr 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP60691562 Issued in WA
Legal business name
PORT OF ANGELS PEDIATRICS, PC
Doing business as
Port of Angels Pediatrics
Practice address
2844 W Edgewood Dr
Port Angeles, WA 98363-9510
Phone
(615) 618-3812
NPI assigned
Apr 3, 2017
Last updated
Apr 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2017

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

Authorized official

Name
Mrs. Kalli Mae Jones, C.P.N.P.NPI 1043546021
Title
President/Nurse Practitioner
Phone
(360) 460-9493

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X AP60691562 WA Primary

Addresses

Primary practice location

2844 W Edgewood Dr
Port Angeles, WA 98363-9510

Mailing address

2844 W Edgewood Dr
Port Angeles, WA 98363-9510
Phone (615) 618-3812

Other names 1

  • Port of Angels Pediatrics Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1487186888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2844 W EDGEWOOD DR",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639510",
            "telephone_number": "615-618-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2844 W EDGEWOOD DR",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983639510",
            "telephone_number": "615-618-3812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT OF ANGELS PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "KALLI",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "PRESIDENT/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "360-460-9493",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "C.P.N.P."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP60691562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port of Angels Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Angeles, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.