Individual provider Active NPI

Jennifer Dawn Nolt, NP-C

  • Pediatric Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1225175821
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
11880 Issued in CA
Practice address
290 N Wayte LN # 1300
Fresno, CA 93701-2124
Phone
(866) 342-6012
NPI assigned
Jan 31, 2007
Last updated
Jan 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 11880 CA
Pediatric Nurse Practitioner 363LP0200X 11880 CA Primary

Addresses

Primary practice location

290 N Wayte LN # 1300
Fresno, CA 93701-2124

Mailing address

2625 E Divisadero St
Fresno, CA 93721-1431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20091021000076 CA Practitioner - Nurse Practitioner 4587701792 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11880CAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
University Faculty Associates, Inc. CurrentSince Apr 1, 2015 Accepting new patients
Community Foundation Medical Group CurrentSince Aug 1, 2018 Accepting new patients
Central California Faculty Medical Group, Inc. Current Accepting new patients
Community Foundation Medical Group Current Accepting new patients
University Faculty Associates , Inc. CurrentSince Apr 1, 2015 Accepting new patients

Locations

2335 E Kashian Ln
Ste 240
Fresno, CA 93701
Phone (559) 320-0545

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

2335 E Kashian Ln
Ste 410
Fresno, CA 93701
Phone (559) 266-4100

2625 E Divisadero St
Fresno, CA 93721
Phone (559) 453-5200

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

290 N Wayte Ln
Fresno, CA 93701
Phone (559) 459-4101

290 N Wayte Ln
#1300
Fresno, CA 93701
Phone (866) 342-6012

Interoperability endpoints

  • Direct secure messaging: jennifer.nolt.1@17661.direct.athenahealth.com

Organizations & group practices 5

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578614400000",
    "number": "1225175821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 N WAYTE LN # 1300",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937012124",
            "telephone_number": "866-342-6012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOLT",
        "first_name": "JENNIFER",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "11880",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "11880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.