Odessa Ann Bacon, ARNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61005962 Issued in WA

Practice address

9330 59TH Ave SW
Lakewood, WA 98499-2858

Phone

(253) 936-5937

NPI assigned

Nov 15, 2007

Last updated

Nov 4, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Greater Lakes Mental Health Foundation Inc

  dba Greater Lakes Mental Healthcare

  • Mental Illness Community Based Residential Treatment Facility
  • Lakewood, WA
  • NPI 1225039811
  Medicare reassignment NPD
• Multicare Health System

  dba Multicare Neurological Surgery

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment NPD
• Multicare Health System

  dba MultiCare Deaconess Retail Pharmacy

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD
• Multicare Health System

  • Diagnostic Radiology Physician
  • Spokane, WA
  • NPI 1679042188
  NPD

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

{
    "created_epoch": "1195084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1801077169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9330 59TH AVE SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992858",
            "telephone_number": "253-936-5937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9330 59TH AVE SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992858",
            "telephone_number": "253-936-5937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "ODESSA",
        "middle_name": "ANN",
        "credential": "ARNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-15",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61005962",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00175337",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Ayers
• Shalimar M Ayuso-Larson
• Back 2 Life Chiropractic (Ruckers Chiropractic)
• Jan Garver Bacon, PHD
• Katherine Louise Bacon, PT, DPT
• Sheree Badders, REGISTERED NURSE
• Jayna Badgero
• Parwinder K Badyal
• Tae H Bae, DO
• Jong Gab Baeg, MTOM

• Psychiatric/Mental Health Nurse Practitioner in Lakewood, WA
• Providers in Lakewood, 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 Nov 4, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.