Individual provider Active NPI

Laurie Ann Fenton, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Jamestown, NY
National Provider Identifier
1053687186
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP014720 Issued in PA
Practice address
107 Institute St # NA
Jamestown, NY 14701-6628
Phone
(716) 484-4334
NPI assigned
Mar 22, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 574957-1 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401506 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP014720 PA Primary

Addresses

Primary practice location

107 Institute St # NA
Jamestown, NY 14701-6628

Mailing address

107 Institute St # NA
Jamestown, NY 14701-6628
Phone (716) 484-4334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, PA2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121204000230 NY Practitioner - Nurse Practitioner 7012169741 Reassigns benefits to 2 organizations
I20150507002195 PA Practitioner - Nurse Practitioner 7012169741 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jamestown Psychiatric PCGroup PAC ID 0244314631, 15 clinicians

Practice addresses (Care Compare)

1465 Foote Ave Ext
Jamestown, NY 14701-9383
Phone (716) 526-4041

20 Gillis Ave
Ridgway, PA 15853-1604
Phone (814) 772-5741

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
574957-1NYMDRegistered Nurse
F401506NYMDPsychiatric/Mental Health Nurse Practitioner
SP014720PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Warren General Hospital CurrentSince Sep 23, 2023 Accepting new patients
Jamestown Psychiatric PC CurrentSince Mar 5, 2024 Accepting new patients
The Chautauqua Center, Inc CurrentSince Jun 15, 2024 Accepting new patients
Warren General Hospital CurrentSince Nov 20, 2023 Accepting new patients
Chautauqua County Chapter of Nysarc Inc CurrentSince Aug 2, 2014 Accepting new patients
Warren General Hospital CurrentSince Sep 23, 2023 Accepting new patients

Locations

1134 Central Ave
Dunkirk, NY 14048
Phone (716) 366-6036

107 Institute St
Jamestown, NY 14701
Phone (716) 484-4334

200 Dunham Ave
Jamestown, NY 14701
Phone (716) 661-1400

890 E 2nd St
Jamestown, NY 14701
Phone (716) 661-1447

1465 Foote Avenue Ext
Jamestown, NY 14701
Phone (716) 526-4041

20 Gillis Ave
Unit 6
Ridgway, PA 15853
Phone (814) 772-5741

20 Gillis Ave
Ridgway, PA 15853
Phone (716) 526-4041

2 W Crescent Park
Warren, PA 16365
Phone (814) 452-5337

103 W Saint Clair St
Rm 2A
Warren, PA 16365
Phone (814) 723-1212

2 W Crescent Park
#P
Warren, PA 16365
Phone (814) 723-3300

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1053687186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 INSTITUTE ST # NA",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016628",
            "telephone_number": "716-484-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 INSTITUTE ST # NA",
            "city": "JAMESTOWN",
            "state": "NY",
            "postal_code": "147016628",
            "telephone_number": "716-484-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENTON",
        "first_name": "LAURIE",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-22",
        "last_updated": "2024-07-16",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "574957-1",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401506",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP014720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamestown, NY

Sources for this page

Verify at the official NPI Registry.