Active NPI
Jennifer W Kooistra, RN, BSN
- Registered Nurse
- Vancouver, WA
National Provider Identifier
1710471065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN60758434
- Practice address
- 2009 NE 117TH St Ste 101
Vancouver, WA 98686-4022 - Phone
- (360) 566-9112
- Fax
- (360) 566-9133
- NPI assigned
- Jun 20, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN60758434 | WA | Primary |
Addresses
Primary practice location
2009 NE 117TH St Ste 101
Vancouver, WA 98686-4022
Mailing address
2009 NE 117TH St Ste 101
Vancouver, WA 98686-4022
Phone (360) 566-9112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN60758434 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529452800000",
"number": "1710471065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 NE 117TH ST STE 101",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986864022",
"telephone_number": "360-566-9112",
"fax_number": "360-566-9133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2009 NE 117TH ST STE 101",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986864022",
"telephone_number": "360-566-9112",
"fax_number": "360-566-9133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOISTRA",
"first_name": "JENNIFER",
"middle_name": "W",
"credential": "RN, BSN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-20",
"last_updated": "2018-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN60758434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.