Individual provider Active NPI

Ayub Mwaura, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • University Place, WA
National Provider Identifier
1780354944
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP61210102 Issued in WA
Practice address
4007 Bridgeport Way W Ste B
University Place, WA 98466-4330
Phone
(425) 640-7009
Fax
(206) 594-6141
NPI assigned
Sep 17, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61210102 WA Primary

Addresses

Primary practice location

4007 Bridgeport Way W Ste B
University Place, WA 98466-4330

Mailing address

PO Box 65512
Tacoma, WA 98464-1512
Phone (919) 810-4436

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20211101001362 WA Practitioner - Nurse Practitioner 2668860222 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

4007 Bridgeport Way W
Suite B
University Place, WA 98466-4330
Phone (253) 234-4195

Hospital & facility affiliations

  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Therapy Group PC Psychiatric/Mental Health CurrentSince Mar 3, 2022 Accepting new patients
Access Holistic Care PLLC Psychiatric/Mental Health CurrentSince Feb 1, 2023 Accepting new patients

Locations

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698

320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113

7100 Fort Dent Way
Ste 220
Tukwila, WA 98188
Phone (206) 708-7274

4007 Bridgeport Way W
Ste B
University Place, WA 98466
Phone (253) 234-4195

Organizations & group practices 2

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 1

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": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1780354944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65512",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984641512",
            "telephone_number": "919-810-4436",
            "fax_number": "206-594-6141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 BRIDGEPORT WAY W STE B",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664330",
            "telephone_number": "425-640-7009",
            "fax_number": "206-594-6141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MWAURA",
        "first_name": "AYUB",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-17",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61210102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

Verify at the official NPI Registry.