Jacqueline Ingrid Kipp

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

204822 Issued in NY

Practice address

13802 Queens Blvd
Briarwood, NY 11435-2665

Phone

(347) 251-7737

NPI assigned

Nov 23, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1003410713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16731 109TH AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13802 QUEENS BLVD",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "114352665",
            "telephone_number": "347-251-7737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16731 109th Ave",
            "address_purpose": "LOCATION",
            "city": "Jamaica",
            "state": "NY",
            "postal_code": "114332909",
            "country_code": "US",
            "telephone_number": "347-251-7737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIPP",
        "first_name": "JACQUELINE",
        "middle_name": "INGRID",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "204822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "samaritanvillage.org",
            "affiliation": "N",
            "address_1": "13802 Queens Blvd",
            "city": "Briarwood",
            "state": "NY",
            "country_code": "US",
            "postal_code": "114352665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mikhail Khaitov, D.O.
• Leya Kikirov
• Shelly Kim, M.S. ED.
• Elizabeth King, RN
• Erica King, M.S.ED
• Danielle N Klein
• Michael Klien, FNP
• Zinaida Klien, DPM
• Linda Kormendi, PA-C
• Robert Kormendi, M.D.

• Licensed Practical Nurse in Briarwood, NY
• Providers in Briarwood, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.