Individual provider Active NPI

Derby Rousseau, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Everett, WA
National Provider Identifier
1588278154
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
61098690 Issued in WA
Practice address
811 Madison St
Everett, WA 98203-4543
Phone
(425) 212-4200
NPI assigned
Sep 1, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 61098690 WA Primary

Addresses

Primary practice location

811 Madison St
Everett, WA 98203-4543

Mailing address

811 Madison St
Everett, WA 98203-4543
Phone (425) 212-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20210111000668 WA Practitioner - Nurse Practitioner 9032522131 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians
Sunrise Services IncGroup PAC ID 4981799483, 6 clinicians

Practice addresses (Care Compare)

21907 64TH Ave W
Suite 200
Mountlake Terrace, WA 98043-6200
Phone (425) 640-7009

2500 E College Way
Mount Vernon, WA 98273-5862
Phone (360) 336-3762

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61098690WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Snohomish County CurrentSince Nov 13, 2020 Accepting new patients
Community Health Center of Snohomish County CurrentSince Nov 13, 2020 Accepting new patients
Sunrise Services, Inc. CurrentSince Jul 18, 2022 Accepting new patients
Mindful Therapy Group PC Psychiatric/Mental Health CurrentSince Jan 8, 2024 Accepting new patients

Locations

326 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2144

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

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

2500 E College Way
Mount Vernon, WA 98273
Phone (360) 336-3762

21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1588278154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 MADISON ST",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982034543",
            "telephone_number": "425-212-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 MADISON ST",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982034543",
            "telephone_number": "425-212-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSEAU",
        "first_name": "DERBY",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "61098690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.