Micaela T Theisen, DNP, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60577678 Issued in WA

Practice address

Hwy 191 and Hospital Drive
Chinle, AZ 86503

Phone

(928) 674-7090

NPI assigned

Oct 8, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA, TX, WY3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mttheise@yourcarecommunity.org
• Direct secure messaging: mtheisen639741@direct.peacehealth.org

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.

• DHHS PHS Naihs Chinle Comprehensive Health Care Facility

  • General Acute Care Hospital
  • Chinle, AZ
  • NPI 1508800129

  TX

  Medicare reassignment NPD
• Grant County Public Hospital District 1

  • Rural Health Clinic/Center
  • Moses Lake, WA
  • NPI 1619086766
  Medicare reassignment NPD
• Peacehealth

  • Critical Access Hospital
  • Sedro Woolley, WA
  • NPI 1144664954
  Medicare reassignment NPD
• Peacehealth

  • Hospitalist Physician
  • Sedro Woolley, WA
  • NPI 1548698806
  Medicare reassignment NPD
• Sound Physicians Emergency Medicine of Washington PLLC

  • Emergency Medicine Physician
  • Sedro Woolley, WA
  • NPI 1629532064
  Medicare reassignment NPD
• Sound Physicians of Wyoming, LLC

  • Hospitalist Physician
  • Casper, WY
  • NPI 1982982708
  Medicare reassignment NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1023285756

  Nurse Practitioner

  Medicare reassignment NPD
• Whidbey Island Public Hospital District

  • Critical Access Hospital
  • Coupeville, WA
  • NPI 1710927231

  Emergency Medicine

  Medicare reassignment NPD
• DHHS PHS Naihs Chinle Comprehensive Health Care Facility

  • General Acute Care Hospital
  • Tsaile, AZ
  • NPI 1538185715
  NPD
• Grant County Public Hospital District 1

  • Rural Health Clinic/Center
  • Moses Lake, WA
  • NPI 1609112739
  NPD
• Grant County Public Hospital District 1

  • General Acute Care Hospital
  • Moses Lake, WA
  • NPI 1902818883
  NPD
• Hospitalist Medicine Physicians of California-San Bernardino, PC

  • Internal Medicine Physician
  • Bakersfield, CA
  • NPI 1376188078
  NPD

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1902158421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 E 42ND AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992036201",
            "telephone_number": "509-202-8109",
            "fax_number": "856-686-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 191 AND HOSPITAL DRIVE",
            "city": "CHINLE",
            "state": "AZ",
            "postal_code": "86503",
            "telephone_number": "928-674-7090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 E Wheeler Rd",
            "address_purpose": "LOCATION",
            "city": "Moses Lake",
            "state": "WA",
            "postal_code": "988371820",
            "country_code": "US",
            "telephone_number": "509-793-9730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16251 Sylvester Rd SW",
            "address_purpose": "LOCATION",
            "city": "Burien",
            "state": "WA",
            "postal_code": "981663017",
            "country_code": "US",
            "telephone_number": "206-248-4604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Hwy 191 and Hospital Drive",
            "address_purpose": "LOCATION",
            "city": "Chinle",
            "state": "AZ",
            "postal_code": "86503",
            "country_code": "US",
            "telephone_number": "928-674-7090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "MICAELA",
        "middle_name": "T",
        "credential": "DNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "AP60577678",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "NP-1523A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60577678",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60577678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2047222",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• McQueen Suen, DPM
• Makenzy Sufficool, MD
• Calli Jo Swenson, PHARMD
• Elizabeth Edmondston Tarr, MD
• Amy Beth Teplitz, PHARMD
• Karen B Thomas, NURSE
• Evan C Thompson, M.D.
• Maya A Thompson, PHARM.D., BCPS
• Carrie E. Thrasher, RD
• Staci Tokarz, M.S., LCMHC

• Family Nurse Practitioner in Chinle, AZ
• Providers in Chinle, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.