Jessica Kiback, APRN

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

8136 Issued in CT

Practice address

100 Retreat Ave Ste 201
Hartford, CT 06106-2528

Phone

(860) 246-8568

Fax

(860) 493-7798

NPI assigned

Feb 21, 2019

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jessica.kiback.2@10170.direct.athenahealth.com
• Direct secure messaging: jessica.kiback@sjch.eclinicaldirectplus.com
• Direct secure messaging: jessica.kiback.1@10170.direct.athenahealth.com

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.

• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1073653630
  Medicare reassignment NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
  • NPI 1073363768
  NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1780376947
  NPD

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1417414905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RETREAT AVE STE 201",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062528",
            "telephone_number": "860-246-8568",
            "fax_number": "860-493-7798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RETREAT AVE STE 201",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062528",
            "telephone_number": "860-246-8568",
            "fax_number": "860-493-7798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1084 Cromwell Ave",
            "address_purpose": "LOCATION",
            "city": "Rocky Hill",
            "state": "CT",
            "postal_code": "060673445",
            "country_code": "US",
            "telephone_number": "860-246-8568",
            "fax_number": "860-493-7798",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "399 Farmington Ave Ste 230",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "CT",
            "postal_code": "060321944",
            "country_code": "US",
            "telephone_number": "860-246-8568",
            "fax_number": "860-493-7798",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "148 Eastern Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Glastonbury",
            "state": "CT",
            "postal_code": "060334321",
            "country_code": "US",
            "telephone_number": "860-246-8568",
            "fax_number": "860-493-7798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIBACK",
        "first_name": "JESSICA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "12.008136",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CT",
            "license": "8136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zhian Ali Khonsary, MD
• Abraham John Khorasani, MD
• Sadaf Khorasanizadeh, MD
• Abdul Muqeet Khuram, DO
• Cameron Kia, MD
• Roina Kidd-Beason, LCSW
• Andrzej Piotr Kieltyka, PA-C
• Francis Joseph Kiernan, M.D.
• Lana Thibodeau Kiernan, RDH
• Elizabeth Kieschnick, PHD

• Women's Health Nurse Practitioner in Hartford, CT
• Providers in Hartford, CT by specialty
• Women's Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.