Jacklynn A Kment, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

598 Issued in NE

Practice address

1620 S 70TH St Ste 103
Lincoln, NE 68506-1563

Phone

(402) 318-3550

Fax

(402) 318-3546

NPI assigned

Jul 7, 2005

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

Other identifiers 3

Other names 1

• Jacklynn A Fitzke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2018 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eye Surgical Associates, LLC

  • Ophthalmology Physician
  • Lincoln, NE
  • NPI 1417952995
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550534400000",
    "number": "1003813767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 S 70TH ST STE 103",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685061563",
            "telephone_number": "402-318-3550",
            "fax_number": "402-318-3546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 S 70TH ST STE 103",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685061563",
            "telephone_number": "402-318-3550",
            "fax_number": "402-318-3546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KMENT",
        "first_name": "JACKLYNN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2019-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970013133",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "37758",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47065843713",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKLYNN",
            "last_name": "FITZKE",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samuel Kluck
• Mikayla Klug, PHARM.D
• Starrlet Klute, APRN
• Karen Ann Kluthe
• Stefanie Kluthe
• Kristi Lynn Knaak
• Amanda Rae Knapp, M.D.
• Jacey Knapp
• Retha Ann Knapp
• Knaub Counseling Services, Inc.

• Physician Assistant in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.