Traci Michelle Jones, PMHNP - BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Wadena, MN
NPI 1639723588 · NPPES record last updated Apr 22, 2020
Key facts
- NPI
- 1639723588
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 6773 (MN)
- Practice address
- 4 Deerwood Ave NW
Wadena, MN 56482-1253 - Phone
- (218) 631-1360
- NPI assigned
- Jul 29, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Astera Health
Practice addresses (Care Compare)
4 Deerwood Ave NW
Wadena, MN 56482-1253
Phone (218) 631-1360
415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7495
415 Jefferson St N
Wadena, MN 56482-1296
Hospital & facility affiliations
- Astera Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190829000243 | MN | Practitioner - Nurse Practitioner | 2668700634 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6773 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Astera Health | Current |
Accepting new patients | |
| Astera Health | Current |
Accepting new patients | |
| Astera Health | Current | Accepting new patients |
Locations
415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510
4 Deerwood Ave NW
Wadena, MN 56482
Phone (218) 631-1100
Interoperability endpoints
- tjones466054@direct.centracare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 6773 | MN | Yes |
Addresses
Primary practice location
4 Deerwood Ave NW
Wadena, MN 56482-1253
Mailing address
25353 151St Ave
Sebeka, MN 56477-2712
Phone (218) 396-0449
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Wadena | Health Information Exchange (HIE) |
Other providers in Wadena, MN
- Theresa Joyce Howe
- Kathleen Howland
- Tina I Hulse
- Shelby Hunke
- Ann T. Jacobs
- Dawn Marie Kemper
- Shannon Carol Kempf
- Erica Catherine Keppers
- Kirsten Ruth Koentopf
- Jim Kraemer
All providers in Wadena, MN · Psychiatric/Mental Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.