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  7. NPI Record 1699308239

JESSICA MYENDU KABALA
Complete NPI Record 1699308239
Nurse Practitioner in Seattle, WA

NPI Status: Active since February 21, 2020

Contact Information

1100 9TH AVE
SEATTLE, WA
ZIP 98101
Phone: (206) 223-2319
Fax: (206) 341-1405

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider First Line Business Mailing Address
  7. Provider Business Mailing Address City Name
  8. Provider Business Mailing Address State Name
  9. Provider Business Mailing Address Postal Code
  10. Provider Business Mailing Address Country Code If outside U S
  11. Provider Business Mailing Address Telephone Number
  12. Provider Business Mailing Address Fax Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Healthcare Provider Taxonomy Code 2
  28. Provider License Number 2
  29. Provider License Number State Code 2
  30. Healthcare Provider Primary Taxonomy Switch 2
  31. Healthcare Provider Taxonomy Code 3
  32. Provider License Number 3
  33. Provider License Number State Code 3
  34. Healthcare Provider Primary Taxonomy Switch 3
  35. Is Sole Proprietor
  36. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1699308239. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1699308239
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: JESSICA
The city name in the mailing address of the provider being identified.
Provider Middle Name: MYENDU
The middle name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 1100 9TH AVE
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address City Name: SEATTLE
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address State Name: WA
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address Postal Code: 981012756
The city name in the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2062232319
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 2063411405
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1100 9TH AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: SEATTLE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: WA
The date that a record was last updated or changed.
Provider Business Practice Location Address Postal Code: 981012756
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address Country Code If outside U S : US
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address Telephone Number: 2062232319
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2063411405
The State code in the location of the provider being identified.
Provider Enumeration Date: 2/21/2020
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Last Update Date: 1/17/2023
The country code in the location address of the provider being identified.
Provider Gender Code: F
The telephone number associated with the location address of the provider being identified.
Healthcare Provider Taxonomy Code 1: 163WM0705X
The fax number associated with the location address of the provider being identified.
Provider License Number 1: 60696072
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: WA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 363L00000X
Provider License Number 2: AP61084558
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: WA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 363L00000X
Provider License Number 3: 31936
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: TN
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 1/17/2023