Keondra Martinique Rustan, PMHNP-DNP, PH.D

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

ARNP.AP.70007587-NP Issued in WA

Practice address

1600 S Lane St
Seattle, WA 98144-2810

Phone

(206) 682-2371

NPI assigned

Aug 29, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 5, 2025 through Aug 5, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1699495929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 164TH ST SW APT 1406",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980873250",
            "telephone_number": "760-895-5514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S LANE ST",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981442810",
            "telephone_number": "206-682-2371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3116 164th St SW Apt 1406",
            "address_purpose": "LOCATION",
            "city": "Lynnwood",
            "state": "WA",
            "postal_code": "980873250",
            "country_code": "US",
            "telephone_number": "760-895-5514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSTAN",
        "first_name": "KEONDRA",
        "middle_name": "MARTINIQUE",
        "name_prefix": "Dr.",
        "credential": "PMHNP-DNP, PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-29",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "ARNP.AP.70007587-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Russo, LICSW, CDP
• Anne Marie Rust
• Nancy Myers Rust
• Monika J Rustad, OT
• James M Rustamier, PAC
• Eric William Rustemier, DMD
• Rachel Rustin
• Eva Rustja
• Ruston Therapy PLLC
• Delaney Ruston, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Seattle, WA
• Providers in Seattle, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.