Active NPI
Jacqueline Fahy
- Registered Nurse
- Olean, NY
National Provider Identifier
1174085161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 736331
- Practice address
- 1 Leo Moss Dr Ste 4308
Olean, NY 14760-1100 - Phone
- (716) 373-8040
- Fax
- (716) 701-3729
- NPI assigned
- Apr 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 736331 | NY | Primary |
Addresses
Primary practice location
1 Leo Moss Dr Ste 4308
Olean, NY 14760-1100
Mailing address
1 Leo Moss Dr Ste 4308
Olean, NY 14760-1100
Phone (716) 373-8040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00635098 | Medicaid | NY |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 736331 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554076800000",
"number": "1174085161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LEO MOSS DR STE 4308",
"city": "OLEAN",
"state": "NY",
"postal_code": "147601100",
"telephone_number": "716-373-8040",
"fax_number": "716-701-3729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 LEO MOSS DR STE 4308",
"city": "OLEAN",
"state": "NY",
"postal_code": "147601100",
"telephone_number": "716-373-8040",
"fax_number": "716-701-3729"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHY",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-01",
"last_updated": "2019-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "736331",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00635098",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olean, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.