Lashaunda Renee Jethro, PMHNP, DNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

NP95017852 Issued in CA

Practice address

4290 Polk Ave
San Diego, CA 92105-1524

Phone

(619) 563-0250

Fax

(858) 633-4681

NPI assigned

Jun 25, 2021

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Fusion Care Group a Psychological Professional CorporationGroup PAC ID 8921433590, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Fusion Care Group, a Psychological Professional Corporation

  • Clinical Psychologist
  • Alpine, CA
  • NPI 1275177982
  Medicare reassignment Care Compare group NPD
• Psychiatric Nursing Consultant PC

  • Nursing Care Agency
  • Sacramento, CA
  • NPI 1215666847
  Medicare reassignment Authorized official
• Help Administrative Services Inc

  • Psychologist
  • San Diego, CA
  • NPI 1629875273
  Medicare reassignment NPD
• Medi Psych Services Inc

  • Child & Adolescent Psychiatry Physician
  • Sherman Oaks, CA
  • NPI 1326665316
  Medicare reassignment NPD

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1497325187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31378 BRUSH CREEK CIR",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925917418",
            "telephone_number": "618-789-1081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4290 POLK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051524",
            "telephone_number": "619-563-0250",
            "fax_number": "858-633-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETHRO",
        "first_name": "LASHAUNDA",
        "middle_name": "RENEE",
        "credential": "PMHNP, DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95127420",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "NP95017852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Elizabeth Jester, MSW
• Jesus H. Lao MD Inc
• Sunil P Jeswani, M.D.
• Jennifer Patricia Jeter, MFT
• Samia Hana Jetha
• Megan Jett, CNM, WHNP
• Angie Jeu, M.S. CCC-SLP
• Michael Herbert Jew
• Jewel in the Lotus Healing
• Jamie Jewell

• Psychiatric/Mental Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.