Jaqulyn Nikole Carrell, M.ED, ATC, LAT, CKTP

Primary specialty

SpecialistTaxonomy code 174400000X

License

A1 60486324 Issued in WA

Practice address

3910 Montlake Blvd NE
Seattle, WA 98195-0001

Phone

(317) 286-8881

NPI assigned

Jul 22, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1497130207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 HIGHLAND LAKE WAY",
            "city": "BROWNSBURG",
            "state": "IN",
            "postal_code": "461127833",
            "telephone_number": "317-286-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 MONTLAKE BLVD NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981950001",
            "telephone_number": "317-286-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRELL",
        "first_name": "JAQULYN",
        "middle_name": "NIKOLE",
        "name_prefix": "Miss",
        "credential": "M.ED, ATC, LAT, CKTP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-22",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "A1 60486324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Carr, LICSW
• Rotonya L Carr, MD
• Kevin G Carrabine
• John Carrel, LMP
• Brian Christopher Carrell
• Margie Carrell
• Marlene Rebecca Carricaburu
• David Carrick, M.D.
• Lydia G Carrick, LMHC, LPC, NCC
• Carrie Cole, PLLC

• Specialist in Seattle, WA
• Providers in Seattle, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; 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.