Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jerice Lake

Individual provider Registered Nurse · NPI 1154878072

Jerice Lake is a Nurse Practitioner in Mesa, Arizona. Qualified in 2021, 5 years ago. Practices with Seattle Childrens Hospital, a 111-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
5
Licensed in
AZ
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

2343 W Main St Apt 2030
Mesa, AZ 85201-9003
Phone: (340) 642-4597
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 264646 (AZ)
Registered Nurse Taxonomy 163W00000X · Licence RN198973 (AZ)

Record details

NPI number1154878072
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 8, 2016
Last updated in NPPESFebruary 28, 2022
Certification dateFebruary 28, 2022
Mailing address400 N Coronado St Apt 3010, Chandler, AZ 85224-3207

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Seattle Childrens Hospital — 111 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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