Jennifer L Keller, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12.009086 Issued in CT

Practice address

170 Grandview Ave Ste 1
Waterbury, CT 06708-2577

Phone

(203) 759-3666

NPI assigned

Jun 27, 2020

Last updated

Nov 12, 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 names 1

• Jennifer Lyn Cappello Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568

  Registered Nurse

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1593216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1396362125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 NORFOLK RD",
            "city": "LITCHFIELD",
            "state": "CT",
            "postal_code": "067592514",
            "telephone_number": "860-201-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 GRANDVIEW AVE STE 1",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082577",
            "telephone_number": "203-759-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-27",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12.009086",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "134738",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Jennifer.Cappello@wtbyhosp.org",
            "affiliation": "Y",
            "endpointDescription": "Employee Email",
            "affiliationName": "Waterbury Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Employee Email",
            "address_1": "170 Grandview Ave Ste 1",
            "city": "Waterbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067082577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CAPPELLO",
            "middle_name": "LYN",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maureen Elizabeth Keaveney
• Katherine Kedzierski, M.D.
• Andrew F. Keene, DMD
• Raeven B Keene
• Andrew Keliar, LCSW
• Grace Kelley, CRNA, APRN
• Samuel Kellner, DPM
• Elizabeth Anne Kelly, MD
• Krista G Kelly, BA,AS
• Paul F Kelly, M.D.

• Family Nurse Practitioner in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.