Melissa R Ottenbacher, ARNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

AP60103856 Issued in WA

Practice address

450 S Kitsap Blvd
Ste 2300
Port Orchard, WA 98366-3773

Phone

(360) 895-0216

Fax

(360) 895-7919

NPI assigned

Nov 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Ms. Melissa Renee Phelps Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kitsap Childrens Clinic LLP

  • Pediatrics Physician
  • Port Orchard, WA
  • NPI 1720175672
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1922099696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9951 MICKELBERRY RD NW",
            "address_2": "STE 101",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983838309",
            "telephone_number": "360-692-9362",
            "fax_number": "360-392-6214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 S KITSAP BLVD",
            "address_2": "STE 2300",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983663773",
            "telephone_number": "360-895-0216",
            "fax_number": "360-895-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTENBACHER",
        "first_name": "MELISSA",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP60103856",
            "primary": true
        },
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "WA",
            "license": "RN00167987",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9662412",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "RN00167987",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARNP LICENSE",
            "identifier": "AP60103856",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "PHELPS",
            "middle_name": "RENEE",
            "prefix": "MS.",
            "credential": "PNP FNP MSN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laurie Ann Oneill, M.D.
• Taylor Orcutt
• Olga Osborn, LMP
• Sheila May Osera
• Joseph L Ostheller, DDS
• Andrew Michael Owen, D.O.
• Ariana Sage Ozog
• Pacific Physical Therapy PLLC
• Nicole Marie Padmos, DPT
• Brenda D Page, LMP

• Pediatric Nurse Practitioner in Port Orchard, WA
• Providers in Port Orchard, WA by specialty
• Pediatric Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.