Jenney Jenean Gannon, BSN,RN,INTERN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61528738 Issued in WA

Practice address

1321 Colby Ave
Everett, WA 98201-1665

Phone

(425) 258-7390

NPI assigned

Oct 25, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jenney Jenean Fry Former name

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Health and Services- WashingtonGroup PAC ID 8325100480, 527 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Regional Medical Center Everett Hospital, Everett, WA, CCN 500014

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jgannon756435@wm.providencedirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Health & Services- Washington

  dba PMG NW Wa

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment Care Compare group NPD
• Providence Health & Services-Wa

  • Mammography Clinic/Center
  • Everett, WA
  • NPI 1336390442
  Medicare reassignment NPD
• Providence Health & Services - Washington

  dba PMG NW WA Physiatry

  • Physical Medicine & Rehabilitation Physician
  • Everett, WA
  • NPI 1740432731
  NPD
• Providence Health & Services-Wa

  • Clinic/Center
  • Everett, WA
  • NPI 1972819175
  NPD
• Providence Health & Services-Washington

  dba Providence Surgery Center, Pacific Campus

  • Ambulatory Surgical Clinic/Center
  • Everett, WA
  • NPI 1588294854
  NPD

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

• Providence Health & Services-Wa

  dba Providence Regional Medical Center Everett

  • Hospitalist Physician
  • Everett, WA
  • NPI 1649615220
  Care Compare affiliation
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  Care Compare affiliation

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

{
    "created_epoch": "1698192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1710759550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "425-525-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 COLBY AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982011665",
            "telephone_number": "425-258-7390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4526 Federal Ave",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982032132",
            "country_code": "US",
            "telephone_number": "425-349-6200",
            "fax_number": "425-349-6855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANNON",
        "first_name": "JENNEY",
        "middle_name": "JENEAN",
        "credential": "BSN,RN,INTERN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-25",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61528738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNEY",
            "last_name": "FRY",
            "middle_name": "JENEAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Evangeline Cua Gan, MD
• Marie Louise Gandee-Windhorn
• Kapil Gangwal, MBBS
• Anika Cole Gannon, CNM, DNP, ARNP
• Carl Gannon, PA
• Ashley Ganser, PHARMD
• Veronica Garaycoa
• Louann Garceau
• Lorena Garcia Gonzalez
• Larissa Flor Garcia Halbert

• Psychiatric/Mental Health Nurse Practitioner in Everett, WA
• Providers in Everett, 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 Feb 12, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.