Active NPI
Jesica Odongi
- Family Nurse Practitioner
- Tacoma, WA
National Provider Identifier
1639822786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP61245108
- Practice address
- 3629 S D St
Tacoma, WA 98418-6813 - Phone
- (253) 649-1406
- NPI assigned
- Jan 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP61245108 | WA | Primary |
Addresses
Primary practice location
3629 S D St
Tacoma, WA 98418-6813
Mailing address
32278 48TH CT S
Auburn, WA 98001-2632
Phone (302) 544-2834
Other practice location 1
8415 Myers Rd E
Bonney Lake, WA 98391-7043
Phone (253) 470-8078
Other practice location 2
32278 48th Ct S
Auburn, WA 98001-2632
Phone (302) 544-2834
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220412001250 | WA | Practitioner - Nurse Practitioner | 0042606410 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP61245108 | WA | MD | Family Nurse Practitioner |
Interoperability endpoints
- jodongi@landmarkhealth-direct.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683763200000",
"number": "1639822786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32278 48TH CT S",
"city": "AUBURN",
"state": "WA",
"postal_code": "980012632",
"telephone_number": "302-544-2834",
"fax_number": "844-529-8515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3629 S D ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984186813",
"telephone_number": "253-649-1406"
}
],
"practiceLocations": [
{
"address_1": "8415 Myers Rd E",
"address_purpose": "LOCATION",
"city": "Bonney Lake",
"state": "WA",
"postal_code": "983917043",
"country_code": "US",
"telephone_number": "253-470-8078",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "32278 48th Ct S",
"address_purpose": "LOCATION",
"city": "Auburn",
"state": "WA",
"postal_code": "980012632",
"country_code": "US",
"telephone_number": "302-544-2834",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ODONGI",
"first_name": "JESICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-29",
"last_updated": "2023-05-11",
"certification_date": "2023-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP61245108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.