NPIMap

Individual provider Active NPI

Nichole Lavender, PA-C

  • Physician Assistant
  • Port Townsend, WA
National Provider Identifier
1669071502
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
61101345 Issued in WA
Practice address
834 Sheridan St Ste B
Port Townsend, WA 98368-2443
Phone
(360) 385-2200
Fax
(360) 344-3095
NPI assigned
Oct 21, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 61101345 WA Primary

Addresses

Primary practice location

834 Sheridan St Ste B
Port Townsend, WA 98368-2443

Mailing address

834 Sheridan St
Port Townsend, WA 98368-2443
Phone (360) 385-2200

Other identifiers 1

IdentifierTypeStateIssuer
2175485MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201207001795 WA Practitioner - Physician Assistant 7911319439 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson County Public Hospital District No 2Group PAC ID 4789593708, 151 clinicians

Practice addresses (Care Compare)

1274 7TH St
Port Townsend, WA 98368-2404

Hospital & facility affiliations

  • Jefferson Healthcare Hospital, Port Townsend, WA, CCN 501323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
61101345WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson County Public Hospital District No 2 CurrentSince Feb 8, 2023 Accepting new patients
Jefferson County Public Hospital District No 2 PastSince Feb 8, 2023 Accepting new patients

Locations

1274 7th St
#A
Port Townsend, WA 98368
Phone (360) 385-2204

834 Sheridan St
#B
Port Townsend, WA 98368
Phone (360) 385-2204

915 Sheridan St
Port Townsend, WA 98368
Phone (360) 379-8031

834 Sheridan St
Port Townsend, WA 98368
Phone (360) 344-0400

Interoperability endpoints

  • Direct secure messaging: nsansburn1426069@wm.providencedirect.org

Organizations & group practices 12

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1669071502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 SHERIDAN ST STE B",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983682443",
            "telephone_number": "360-385-2200",
            "fax_number": "360-344-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVENDER",
        "first_name": "NICHOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "61101345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2175485",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Townsend, WA

Sources for this page

Verify at the official NPI Registry.