NPIMap

Individual provider Active NPI

Chelane R Fackenthall, ARNP

  • Nurse Practitioner
  • Walla Walla, WA
National Provider Identifier
1699000901
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP60111177 Issued in WA
Practice address
301 W Poplar St
Suite 100
Walla Walla, WA 99362-2858
Phone
(509) 522-5824
Fax
(509) 522-5738
NPI assigned
Oct 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN00151745 WA
Nurse Practitioner 363L00000X AP60111177 WA Primary

Addresses

Primary practice location

301 W Poplar St
Suite 100
Walla Walla, WA 99362-2858

Mailing address

PO Box 34439
Seattle, WA 98124-1439

Other identifiers 2

IdentifierTypeStateIssuer
1699000901MedicaidWA
500616387MedicaidOR

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cfackenthall186054@wm.providencedirect.org Direct

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
I20101027001317 WA Practitioner - Nurse Practitioner 3274727888 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

301 W Poplar St
Suite 50
Walla Walla, WA 99362-2800
Phone (509) 897-8300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN00151745WAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Jul 26, 2010 Accepting new patients
Providence Health & Services - Washington CurrentSince Jul 26, 2010 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

301 W Poplar St
Ste 50
Walla Walla, WA 99362
Phone (509) 522-5765

301 W Poplar St
Ste 100
Walla Walla, WA 99362
Phone (509) 522-5824

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

Organizations & group practices 3

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 7

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": "1254700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1699000901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W POPLAR ST",
            "address_2": "SUITE 100",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622858",
            "telephone_number": "509-522-5824",
            "fax_number": "509-522-5738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKENTHALL",
        "first_name": "CHELANE",
        "middle_name": "R",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-05",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00151745",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60111177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699000901",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500616387",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cfackenthall186054@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "301 W Poplar St",
            "address_2": "Suite 100",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993622858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.