MR. BRIAN JAMES NAKKERUD-WHITESIDE RN PMHFNPC NPI 1417205527

NPI Information

NPI: 1417205527
Provider Name: MR. BRIAN JAMES NAKKERUD-WHITESIDE, RN, PMHFNPC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
1400 EMELINE AVE
SANTA CRUZ, CA
ZIP 95060
Phone: (831) 454-4170
Get Directions

MR. Brian James Nakkerud-whiteside, RN, PMHFNPC is a psychiatric/mental health nurse practitioner in Santa Cruz, CA with 11 years of experience. MR. Brian James Nakkerud-whiteside, RN, PMHFNPC NPI is 1417205527. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1400 EMELINE AVE
SANTA CRUZ, CA
ZIP 95060-976
Phone: (831) 454-4170
Fax: (831) 454-4663

The NPI 1417205527 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/21/2012 and was last updated on 5/11/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		802020	CALIFORNIA	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	23511	CALIFORNIA	Yes
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	87055	CALIFORNIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	FHC70042F	OTHER	CALIFORNIA	MEDI-CAL PTAN GROUP#
2	ZZZ92069Z	OTHER	CALIFORNIA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
3	ZZZ91892Z	OTHER	CALIFORNIA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
4	ZZZ91891Z	OTHER	CALIFORNIA	SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
5	FHC70044F	OTHER	CALIFORNIA	MEDI-CAL PTAN GROUP#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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