Active NPI
Mary Linda Jacky, R.N.
- Registered Nurse
- Erie, PA
National Provider Identifier
1023245974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN201566L
- Practice address
- 1031 State St
Suite D
Erie, PA 16501-1803 - Phone
- (814) 455-7827
- Fax
- (814) 455-7831
- NPI assigned
- Jun 18, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN201566L | PA | Primary |
Addresses
Primary practice location
1031 State St
Suite D
Erie, PA 16501-1803
Mailing address
1031 State St
Suite D
Erie, PA 16501-1803
Phone (814) 455-7827
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN201566L | PA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1023245974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1031 STATE ST",
"address_2": "SUITE D",
"city": "ERIE",
"state": "PA",
"postal_code": "165011803",
"telephone_number": "814-455-7827",
"fax_number": "814-455-7831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1031 STATE ST",
"address_2": "SUITE D",
"city": "ERIE",
"state": "PA",
"postal_code": "165011803",
"telephone_number": "814-455-7827",
"fax_number": "814-455-7831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKY",
"first_name": "MARY",
"middle_name": "LINDA",
"name_prefix": "Mrs.",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-18",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "PA",
"license": "RN201566L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.