Jerice Lake
NPI 1154878072ActiveIndividual· Nurse Practitioner, Pediatrics· Mesa, AZ
Nurse Practitioner, Pediatrics with Seattle Childrens Hospital, practicing in Mesa, Arizona. Enrolled in Medicare as practitioner - nurse practitioner.
Overview
| NPI | 1154878072 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Sep 8, 2016 |
| Last updated in NPPES | Feb 28, 2022 |
| Certified by provider | Feb 28, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Pediatrics Primary | 363LP0200X | 264646 | AZ |
| Registered Nurse | 163W00000X | RN198973 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (WA) |
|---|
Education and affiliations
| Graduation year | 2021 |
|---|---|
| Medicare specialty | Nurse Practitioner |
Medical group
- Seattle Childrens HospitalSeattle, WA · 107 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
Other pediatric nurse practitioners in Mesa
- 1225161763
- 1124526884
- 1134613607
- 1245375955
- 1326472150
- 1386785095
- 1457312340
- 1487224382
- 1518286210
- 1730302753
- 1770731507
- 1780642413
All 29 pediatric nurse practitioners in Mesa · All pediatric nurse practitioners in Arizona