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

Mr. Jack Logan Keith Jr., PMHNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1982968210

Mr. Jack Logan Keith Jr., PMHNP is a Nurse Practitioner in University Place, Washington. Qualified in 2018, 8 years ago. Practices with Mindful Therapy Group PC, a 646-clinician group and accepts Medicare assignment. Licensed in Oregon and Washington.

Years since qualifying
8
Licensed in
OR, WA
In the registry since
2012
Specialties on file
2
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

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Practice location Address checks out

6102 84th Avenue Ct W
University Place, WA 98467-4042
Phone: (360) 870-5411
Fax: (888) 414-8151
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence AP61193548 (WA)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 202110580NP-PP (OR)

Record details

NPI number1982968210
Entity typeIndividual (Type 1)
GenderMale
Credentials PMHNP
Sole proprietorYes
NPI enumeratedJuly 2, 2012
Last updated in NPPESDecember 3, 2025
Certification dateDecember 3, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Mindful Therapy Group Pc — 646 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in University Place