Jaclyn Kate Anderson

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

191453-30 Issued in WI

Practice address

N7770 Loyalty Rd
Blanchardville, WI 53516-9624

Phone

(608) 214-0173

NPI assigned

Apr 1, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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": "1333238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1033485214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N7770 LOYALTY RD",
            "city": "BLANCHARDVILLE",
            "state": "WI",
            "postal_code": "535169624",
            "telephone_number": "608-214-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N7770 LOYALTY RD",
            "city": "BLANCHARDVILLE",
            "state": "WI",
            "postal_code": "535169624",
            "telephone_number": "608-214-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACLYN",
        "middle_name": "KATE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-01",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "314220031",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "191453-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Beam, MS, CCC-SLP
• Blanchardville Chiropractic Clinic, SC
• Melissa Jane Durst, MS CCC-SLP
• Kaylee A Hermansen
• Peggy Suzanne Hines, M.S. ED., LPC

• Registered Nurse in Blanchardville, WI
• Providers in Blanchardville, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; 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.