NPIMap

Individual provider Active NPI

Megan McKenzie Colburn, ARNP

  • Gerontology Nurse Practitioner
  • Tumwater, WA
National Provider Identifier
1922482074
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
AP60602941 Issued in WA
Practice address
150 Dennis St SW Ste a
Tumwater, WA 98501-5459
Phone
(360) 754-6367
Fax
(360) 754-6429
NPI assigned
Jul 17, 2015
Last updated
Aug 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X RN60314469 WA
Gerontology Nurse Practitioner 363LG0600X AP60602941 WA Primary

Addresses

Primary practice location

150 Dennis St SW Ste a
Tumwater, WA 98501-5459

Mailing address

150 Dennis St SW Ste a
Tumwater, WA 98501-5459
Phone (360) 754-6367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151009001140 WA Practitioner - Nurse Practitioner 6507174661 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoalwater Bay TribeGroup PAC ID 8820986599, 5 clinicians

Practice addresses (Care Compare)

2373 Old Tokeland Rd
BLDG E
Tokeland, WA 98590-0000
Phone (360) 267-0119

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN60314469WAMDAdult Health Nurse Practitioner
AP60602941WAMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shoalwater Bay Tribe CurrentSince Oct 16, 2023 Accepting new patients
Capital Medical Center Physicians LLC CurrentSince Oct 1, 2016 Accepting new patients
Capital Medical Center Physicians LLC CurrentSince Oct 1, 2016 Accepting new patients
Capital Medical Center Specialty Physicians, LLC CurrentSince Oct 9, 2017 Accepting new patients
Tumwater Family Practice Clinic CurrentSince Mar 1, 2020 Accepting new patients

Locations

3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743

3920 Capital Mall Dr SW
Ste 200
Olympia, WA 98502
Phone (360) 459-7282

150 Dennis St SW
#A
Tumwater, WA 98501
Phone (360) 754-6367

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FDHGAA

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1922482074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 DENNIS ST SW STE A",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985015459",
            "telephone_number": "360-754-6367",
            "fax_number": "360-754-6429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 DENNIS ST SW STE A",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985015459",
            "telephone_number": "360-754-6367",
            "fax_number": "360-754-6429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLBURN",
        "first_name": "MEGAN",
        "middle_name": "MCKENZIE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-17",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "RN60314469",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WA",
            "license": "AP60602941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tumwater, WA

Sources for this page

Verify at the official NPI Registry.