NPIMap

Individual provider Active NPI

Jacob Christopher Memmott, NP

  • Family Nurse Practitioner
  • McKinleyville, CA
National Provider Identifier
1497370001
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95030069 Issued in CA
Practice address
1644 Central Ave
McKinleyville, CA 95519-4342
Phone
(707) 839-3068
NPI assigned
Jun 9, 2020
Last updated
Jun 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95030069 CA Primary

Addresses

Primary practice location

1644 Central Ave
McKinleyville, CA 95519-4342

Mailing address

1644 Central Ave
McKinleyville, CA 95519-4342
Phone (707) 839-3068

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250710002987 CA Practitioner - Nurse Practitioner 6103241146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1150 Foster Ave
Arcata, CA 95521-5986
Phone (707) 826-8610

1644 Central Ave
McKinleyville, CA 95519-4342
Phone (707) 839-3068

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95030069CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Snohomish County CurrentSince Jul 6, 2020 Accepting new patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers CurrentSince Apr 17, 2025 Accepting new patients
Community Health Center of Snohomish County CurrentSince Jul 6, 2020 Accepting new patients
Open Door Community Health Centers CurrentSince Apr 17, 2025 Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068

1019 112th St SW
Everett, WA 98204
Phone (425) 551-6001

1424 Broadway
Everett, WA 98201
Phone (425) 551-1000

8609 Evergreen Way
Everett, WA 98208
Phone (425) 551-6200

Interoperability endpoints

  • Direct secure messaging: jmemmott738524@direct.ochin.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1497370001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1644 CENTRAL AVE",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194342",
            "telephone_number": "707-839-3068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 CENTRAL AVE",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194342",
            "telephone_number": "707-839-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEMMOTT",
        "first_name": "JACOB",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-09",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95030069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinleyville, CA

Sources for this page

Verify at the official NPI Registry.