Active NPI
Patricia L Jackson, FNP
- Family Nurse Practitioner
- Mishawaka, IN
National Provider Identifier
1376557702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 71001911A
- Practice address
- 230 W Catalpa Dr
Suite D
Mishawaka, IN 46545-8321 - Phone
- (574) 257-7551
- Fax
- (574) 257-7535
- NPI assigned
- Jul 28, 2006
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 71001911A | IN | Primary |
Addresses
Primary practice location
230 W Catalpa Dr
Suite D
Mishawaka, IN 46545-8321
Mailing address
230 Catalpa
Suite D
Mishawaka, IN 46545
Phone (574) 257-7551
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200519100 | Medicaid | IN |
Other names 1
- Patricia Trethewey
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71001911A | IN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Senior Care, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Physician
- Kokomo, IN
- NPI 1801124953
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562284800000",
"number": "1376557702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 CATALPA",
"address_2": "SUITE D",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "46545",
"telephone_number": "574-257-7551",
"fax_number": "574-257-7535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 W CATALPA DR",
"address_2": "SUITE D",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465458321",
"telephone_number": "574-257-7551",
"fax_number": "574-257-7535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "PATRICIA",
"middle_name": "L",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-28",
"last_updated": "2019-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "71001911A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200519100",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PATRICIA",
"last_name": "TRETHEWEY",
"credential": "FNP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.