Active NPI
Jennette Marie Anderson, PA-C
- Physician Assistant
- Tacoma, WA
National Provider Identifier
1972769412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 19829
- Practice address
- 9040A Jackson Ave Joint Base Lewis-McChord
Tacoma, WA 98431-0001 - Phone
- (909) 560-2683
- NPI assigned
- Aug 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 19829 | CA | Primary |
Addresses
Primary practice location
9040A Jackson Ave Joint Base Lewis-McChord
Tacoma, WA 98431-0001
Mailing address
Wh3S9A
549 HC / Baach Unit 15245
Apo, AP 96271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19829 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626220800000",
"number": "1972769412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "WH3S9A",
"address_2": "549 HC / BAACH UNIT 15245",
"city": "APO",
"state": "AP",
"postal_code": "96271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040A JACKSON AVE JOINT BASE LEWIS-MCCHORD",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "909-560-2683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JENNETTE",
"middle_name": "MARIE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-04",
"last_updated": "2021-07-14",
"certification_date": "2021-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "19829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.