Prestige Mental Health

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

PRESTIGE MENTAL HEALTH

Practice address

7720 190TH Ave E
Bonney Lake, WA 98391-7010

Phone

(253) 293-0683

Fax

(253) 397-4640

NPI assigned

Mar 8, 2024

Organization subpart

No

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

Authorized official

Name

Millicent Mbua, NP

Title

President

Phone

(253) 293-0683

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samwel Mbua, ARNP

  • Family Nurse Practitioner
  • Burien, WA
  • NPI 1821607300
  NPD (past)

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

{
    "created_epoch": "1709856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1881452571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7720 190TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917010",
            "telephone_number": "253-293-0683",
            "fax_number": "253-397-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7720 190TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917010",
            "telephone_number": "253-293-0683",
            "fax_number": "253-397-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-08",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "MBUA",
        "authorized_official_first_name": "MILLICENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-293-0683",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Gayle Phillips, COTA/L
• Gordon Arthur Pomerenke
• Emily R Potter, R.PH.
• Heather Lynn Prescott, LICSW
• Janessa Pallasigui Pressley, PHARM D
• Principal Health Clinic LLC
• Proliance Surgeons Inc P S
• Puget Sound Specialty Physicians PLLC
• Annie Quach, RPH
• Rainier Biobehavioral Institute, LLC

• Nurse Practitioner in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.