Jacklyn Schaffer, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71005316A Issued in IN

Practice address

2514 E Dupont Rd Ste 100
Fort Wayne, IN 46825-1619

Phone

(260) 484-8830

Fax

(260) 483-1911

NPI assigned

Oct 14, 2014

Last updated

May 6, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588723200000",
    "number": "1366846867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2514 E DUPONT RD STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251619",
            "telephone_number": "260-484-8830",
            "fax_number": "260-483-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2514 E DUPONT RD STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251619",
            "telephone_number": "260-484-8830",
            "fax_number": "260-483-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAFFER",
        "first_name": "JACKLYN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71005316A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28191291A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0120115",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201273240",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Sue Schafer-King, M.A.,CCC-SLP
• Adrienne Schafer, NP
• Benjamin Carl Schafer, LAT, ATC
• Linda Schafer, PT
• Matthew Schafer
• Kathleen A Schaffer, CNP
• Katie Louise Schaller, MA, LMHC
• Bethany Schamber, PA
• Mark D Schamber, CAA
• Sara Louise Schamerloh, O.D.

• Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; 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.