Mr Jack Logan Keith Jr, PMHNP in Olympia, WA - Medicare Nurse Practitioner

Mr Jack Logan Keith Jr, PMHNP is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Olympia, Washington. His current practice location is 3857 Martin Way E, Olympia, Washington. You can reach out to his office (for appointments etc.) via phone at (253) 581-7020.

Mr Jack Logan Keith Jr is licensed to practice in Washington (license number AP61193548) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1982968210.

Contact Information

	Mr Jack Logan Keith Jr, PMHNP
	3857 Martin Way E, Olympia, WA 98506
	(253) 581-7020
	Not Available

Map and Direction

Provider's Profile

Full Name	Mr Jack Logan Keith Jr
Gender	Male
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	3857 Martin Way E, Olympia, Washington
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1982968210
Provider Enumeration Date: 07/02/2012
Last Update Date: 12/07/2022

Medicare PECOS Information:

PECOS PAC ID: 0547640385
Enrollment ID: I20220711000995

Medical Identifiers

Medical identifiers for Mr Jack Logan Keith Jr such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1982968210	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	AP61193548 (Washington)	Primary
101YM0800X	Counselor - Mental Health	(* (Not Available))	Secondary
163W00000X	Registered Nurse	N60493722 (Washington)	Secondary
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	202110580NP-PP (Oregon)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Jack Logan Keith Jr allows following entities to bill medicare on his behalf.

Entity Name	Mindful Therapy Group Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1316238678 PECOS PAC ID: 4981872561 Enrollment ID: O20210301001586

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Jack Logan Keith Jr is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mr Jack Logan Keith Jr, PMHNP 3857 Martin Way E, Olympia, WA 98506 Ph: () -	Mr Jack Logan Keith Jr, PMHNP 3857 Martin Way E, Olympia, WA 98506 Ph: (253) 581-7020

Reviews and Comments

Nurse Practitioner Nurses in Olympia, WA

Karen Yepez, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 500 Lilly Rd Ne Ste 201, Olympia, WA 98506 Phone: 360-413-8272 Fax: 360-413-8878
Ms. Melinda Anne Harris-moulton, MSN, ARNP, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 5201 Dolphin Ln Nw, Olympia, WA 98502 Phone: 360-866-8143
Katelin Petrin, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3434 12th Ave Ne, Olympia, WA 98506 Phone: 360-413-8470 Fax: 360-413-8490
Michelle Jennings Hood, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3920 Capital Mall Dr Sw Ste 400, Olympia, WA 98502 Phone: 360-705-1259
Kimberly E Riano, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2950 Limited Ln Nw, Olympia, WA 98502 Phone: 360-706-2763 Fax: 360-350-0735
Dara S Bernal, AP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3516 7th Ave Sw, Olympia, WA 98502 Phone: 360-489-2906
Madeleine Reed, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 209 Lilly Rd Ne Ste B, Olympia, WA 98506 Phone: 604-138-2503

Mr Jack Logan Keith Jr, PMHNP - Medicare Nurse Practitioner in Olympia, WA