Jennifer Otty, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

237870 Issued in NY

Practice address

4 Marlene Dr
Albany, NY 12205-1704

Phone

(518) 801-4135

NPI assigned

Apr 6, 2016

Reactivated

Oct 18, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1134583255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MARLENE DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051704",
            "telephone_number": "518-801-4135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MARLENE DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122051704",
            "telephone_number": "518-801-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTY",
        "first_name": "JENNIFER",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-06",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "deactivation_date": "2016-06-09",
        "reactivation_date": "2017-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "LP038497",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "237870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Albany, NY
• Providers in Albany, 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 Mar 1, 2021; 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.