Jeriica Kelly Weatherup

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

321769 Issued in NY

Practice address

650 State Street
Watertown, NY 13601-1251

Phone

(315) 755-1251

Fax

(315) 291-6601

NPI assigned

Dec 26, 2023

Last updated

Dec 26, 2023By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Citizen Advocates, Inc

  dba North Star Behavioral Health Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Malone, NY
  • NPI 1780619064
  NPD

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

{
    "created_epoch": "1703548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1063281558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 SCIO ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136012451",
            "telephone_number": "315-921-1878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 STATE STREET",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011251",
            "telephone_number": "315-755-1251",
            "fax_number": "315-291-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERUP",
        "first_name": "JERIICA",
        "middle_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-26",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "321769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PRACTICAL NURSE",
            "identifier": "321769",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alta Louise Watkins, PA
• Patricia Marcelle Watts, SLP
• Jeffrey D Way, MD
• Lawrence E. Way, DDS
• David L Weal, LCSW
• Danyelle May Weaver, LPN
• Kriston Webb, MASTER
• Daniel J Weber, MD
• Hallie Alice Weinman
• Gerald S Weinstein, MD

• Licensed Practical Nurse in Watertown, NY
• Providers in Watertown, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; 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.