Jacqueline A Gillern, CRNP-APMH

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP019487 Issued in PA

Practice address

11 Farview Rd
Waymart, PA 18472-7700

Phone

(570) 488-5811

NPI assigned

Nov 26, 2018

Last updated

Nov 26, 2018By 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

Medicare fee-for-service enrollment

Enrolled in PA

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 1

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Children's Service Center of Wyoming Valley IncGroup PAC ID 1052567617, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Children's Service Center of Wyoming Valley, Inc

  • Counselor
  • Wilkes Barre, PA
  • NPI 1700861242
  Medicare reassignment Care Compare group NPD
• Children's Service Center of Wyoming Valley, Inc

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1710617857
  NPD

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

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1063982759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 WHITE OAK DR",
            "city": "OLYPHANT",
            "state": "PA",
            "postal_code": "184472251",
            "telephone_number": "570-382-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 FARVIEW RD",
            "city": "WAYMART",
            "state": "PA",
            "postal_code": "184727700",
            "telephone_number": "570-488-5811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLERN",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "credential": "CRNP-APMH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP019487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edwin Daniels, PAC
• Kristen M. Daniels, PA-C
• Mary Edlind
• Janet B Eisele, MSN, CRNP, C
• Jessica Giannetti, CRNP
• Maureen Gilroy, OT
• Gods Mountain Recovery Center
• Thomas Gavin Gravine
• Chelsea Grecco, PA-C
• Nicholas Heasley, DC

• Psychiatric/Mental Health Nurse Practitioner in Waymart, PA
• Providers in Waymart, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.