NPIMap

Individual provider Active NPI

Jordyn D Noullet, CRNP

  • Nurse Practitioner
  • Scranton, PA
National Provider Identifier
1013636265
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP026133 Issued in PA
Practice address
1800 Mulberry St
Scranton, PA 18510-2369
Phone
(570) 703-8231
Fax
(570) 703-8250
NPI assigned
Aug 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X SP026133 PA
Nurse Practitioner 363L00000X SP026133 PA Primary

Addresses

Primary practice location

1800 Mulberry St
Scranton, PA 18510-2369

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other names 1

  • Jordyn D Noullet Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221013000066 PA Practitioner - Nurse Practitioner 7214303429 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Pennsylvania State University College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

1800 Mulberry St
Scranton, PA 18510-2369
Phone (570) 969-7355

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Nurse Practitioner Current Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
The Milton S Hershey Medical Center Physcian Group CurrentSince Sep 26, 2022 Accepting new patients
The Milton S Hershey Medical Center Physician Group CurrentSince Sep 26, 2022 Accepting new patients
Geisinger Clinic CurrentSince Oct 2, 2023 Accepting new patients
Geisinger Clinic Nurse Practitioner CurrentSince Oct 2, 2023 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

500 University Dr
#41
Hershey, PA 17033
Phone (717) 531-8202

500 University Dr
Hershey, PA 17033
Phone (717) 531-8181

500 University Dr
#410
Hershey, PA 17033
Phone (717) 531-1159

400 Highland Ave
Lewistown, PA 17044
Phone (717) 242-7473

1800 Mulberry St
Scranton, PA 18510
Phone (570) 703-7351

1000 E Mountain Blvd
Wilkes Barre, PA 18711
Phone (570) 808-7399

Organizations & group practices 7

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1013636265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 MULBERRY ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185102369",
            "telephone_number": "570-703-8231",
            "fax_number": "570-703-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOULLET",
        "first_name": "JORDYN",
        "middle_name": "D",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-23",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "PA",
            "license": "SP026133",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP026133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDYN",
            "last_name": "NOULLET",
            "middle_name": "D",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.