Active NPI
Jeffrey Daniel Whitaker, DNP, PMHNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Portland, OR
National Provider Identifier
1578285219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- 202213055NP-PP
- Practice address
- 1201 SW 12TH Ave
Portland, OR 97205-2046 - Phone
- (971) 251-9856
- NPI assigned
- Sep 19, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 202213055NP-PP | OR | Primary |
Addresses
Primary practice location
1201 SW 12TH Ave
Portland, OR 97205-2046
Mailing address
1446A 5TH Ave
Fort Knox, KY 40121-2223
Phone (903) 283-0834
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 14, 2023 through Feb 14, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202213055NP-PP | OR | MD | Psychiatric/Mental Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1578285219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1446A 5TH AVE",
"city": "FORT KNOX",
"state": "KY",
"postal_code": "401212223",
"telephone_number": "903-283-0834"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 SW 12TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052046",
"telephone_number": "971-251-9856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITAKER",
"first_name": "JEFFREY",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "DNP, PMHNP-BC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "OR",
"license": "202213055NP-PP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.