Liberty Lake Direct Primary Care PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LIBERTY LAKE DIRECT PRIMARY CARE PLLC

Doing business as

Liberty Lake DPC

Practice address

2207 N Molter Rd
Liberty Lake, WA 99019-7570

Phone

(509) 348-2214

NPI assigned

Jul 4, 2023

Last updated

Jul 4, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

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

Title

Owner

Phone

(509) 828-5250

Specialties & licenses 1

Addresses

Other names 1

• Liberty Lake DPC Doing business as

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

CLIA laboratory certificates

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.

• Jared William Nelson, MD

  • Family Medicine Physician
  • Liberty Lake, WA
  • NPI 1528034980
  NPD Authorized official

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

{
    "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 Chiropractic)
• Liberty Lake Chiropractic PS (Spokane Spine and Disc)
• Liberty Lake Couple and Family Therapy, LLC (Liberty Lake Couple and Family Therapy)
• 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

• Family Medicine Physician in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• 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.