Evergreen Mental Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60654992 Issued in WA

Legal business name

EVERGREEN MENTAL HEALTH LLC

Practice address

23403 E Mission Ave Ste 200I
Liberty Lake, WA 99019-7575

Phone

(509) 992-4224

NPI assigned

Apr 27, 2017

Last updated

Mar 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Regina Davis, ARNPNPI 1952753717

Title

Owner

Phone

(509) 992-4224

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Regina Marie Davis, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Liberty Lake, WA
  • NPI 1952753717
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1740715622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 333",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23403 E MISSION AVE STE 200I",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197575",
            "telephone_number": "509-992-4224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-27",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-992-4224",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60654992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mathew Edwards
• Barry Ehlert, RPH
• Madhu Enjati, PT
• Jared Dean Evans, D.M.D.
• Evergreen Dermatopathology PLLC
• Isabella Faccone
• Family Home Care Corporation
• Family Home Care Corporation
• Family Medicine Liberty Lake P C
• Rachel A Ferrari, ARNP

• Psychiatric/Mental Health Nurse Practitioner in Liberty Lake, WA
• Providers in Liberty Lake, 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 Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.