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

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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