Provider Demographics
NPI:1144896390
Name:MOCK, JAMI L (ARNP)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:L
Last Name:MOCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-779-4444
Mailing Address - Fax:360-697-2514
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY NW STE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-779-4444
Practice Address - Fax:360-697-2514
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60465549163WE0003X
WAAP61259121363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2209334Medicaid