Individual provider Active NPI

Jennifer Rose Anderson, CRRN, CDE, CLNC

  • Rehabilitation Registered Nurse
  • Augusta, GA
National Provider Identifier
1114393956
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Registered NurseTaxonomy code 163WR0400X
License
RN243066 Issued in GA
Practice address
1355 Independence Dr
Augusta, GA 30901-1037
Phone
(706) 826-5808
NPI assigned
Aug 17, 2015
Last updated
Aug 17, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN60270142 WA
Rehabilitation Registered Nurse 163WR0400X 725156 CA
Rehabilitation Registered Nurse 163WR0400X RN243066 GA Primary
Rehabilitation Registered Nurse 163WR0400X RN58436 NV

Addresses

Primary practice location

1355 Independence Dr
Augusta, GA 30901-1037

Mailing address

402 Woodhill TRL
Augusta, GA 30909-2649

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN60270142WAMDRegistered Nurse
725156CAMDRehabilitation Registered Nurse
RN243066GAMDRehabilitation Registered Nurse
RN58436NVMDRehabilitation Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1114393956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 WOODHILL TRL",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309092649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 INDEPENDENCE DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309011037",
            "telephone_number": "706-826-5808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JENNIFER",
        "middle_name": "ROSE",
        "credential": "CRRN, CDE, CLNC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60270142",
            "primary": false
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "CA",
            "license": "725156",
            "primary": false
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "GA",
            "license": "RN243066",
            "primary": true
        },
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "NV",
            "license": "RN58436",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; 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.