Jennifer Ellyn Souders, M.D.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

MD00029678 Issued in WA

Practice address

6808 220TH St SW
North Start Place, Ste 201
Mountlake Terrace, WA 98043-2187

Phone

(425) 640-6976

Fax

(425) 640-6977

NPI assigned

Jun 14, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1922360940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6808 220TH ST SW",
            "address_2": "NORTH START PLACE, STE 201",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432187",
            "telephone_number": "425-640-6976",
            "fax_number": "425-640-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUDERS",
        "first_name": "JENNIFER",
        "middle_name": "ELLYN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-14",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "WA",
            "license": "MD00029678",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00029678",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert H. Small, M.D.
• Angla A Smith
• Robyn Ann Smith, CDP
• Samantha Smith, LMT
• Rayson Takeshi Sorayama, PT
• Sound Pain Alliance
• Mustafa Lutfi M Sowan, PH
• Rebecca Keil Spang, MOTR/L
• Lexus Sparks
• Caroline Spaulding, LMP

• Pain Medicine (Anesthesiology) Physician in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Pain Medicine (Anesthesiology) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.