Liberty Lake Direct Primary Care PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LIBERTY LAKE DIRECT PRIMARY CARE PLLC

Practice address

2207 N Molter Rd
Liberty Lake, WA 99019-7570

Phone

(509) 348-2214

NPI assigned

Jul 4, 2023

Organization subpart

No

Name

Dr. Jared W. Nelson, M.D.NPI 1528034980

Title

Owner

Phone

(509) 828-5250

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jared William Nelson, MD

  • Family Medicine Physician
  • Liberty Lake, WA
  • NPI 1528034980

  Family Medicine

  NPD Authorized official

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

• Liberty Lake DPC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 4, 2023.

{
    "created_epoch": "1688428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688428800000",
    "number": "1558048280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 N MADSON CT",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197507",
            "telephone_number": "509-828-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197570",
            "telephone_number": "509-348-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY LAKE DIRECT PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-04",
        "last_updated": "2023-07-04",
        "certification_date": "2023-07-04",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-828-5250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Lake DPC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patrick Leong, LCSW
• Raymond R Lester, LICSW
• Liberty Chiropractic LLC
• Liberty Lake Chiropractic PS
• Liberty Lake Couple and Family Therapy, LLC
• Liberty Lake Eyecare Center PS
• Liberty Lake Family & Sports Medicine, P.S.
• Liberty Lake Family Dentistry
• Liberty Lake Foot & Ankle PLLC
• Liberty Lake Medical Supply

• All providers in Liberty Lake, WA
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.