Individual provider Active NPI

Jennifer Kladke, NP

  • Nurse Practitioner
  • Williamsville, NY
National Provider Identifier
1073765368
Registry record updated Sep 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
380780 Issued in NY
Practice address
25 Hopkins Rd
Williamsville, NY 14221-4641
Phone
(716) 632-8050
NPI assigned
Oct 17, 2008
Last updated
Sep 24, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 380780 NY Primary

Addresses

Primary practice location

25 Hopkins Rd
Williamsville, NY 14221-4641

Mailing address

25 Hopkins Rd
Williamsville, NY 14221-4641
Phone (716) 632-8050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20250307000543 NY Practitioner - Nurse Practitioner 2668993510 Practice locations: Orchard Park, NY

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1996
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

70 Linwood Ave
Orchard Park, NY 14127-2308
Phone (716) 675-9232

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
380780NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Pediatrics LLC Past Accepting new patients
Amherst Pediatric Associates, P.C. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1224201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253750400000",
    "number": "1073765368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 HOPKINS RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142214641",
            "telephone_number": "716-632-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 HOPKINS RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142214641",
            "telephone_number": "716-632-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLADKE",
        "first_name": "JENNIFER",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-17",
        "last_updated": "2009-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "380780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.