Jackalyn Despaw

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

616272 Issued in NY

Practice address

56 Market St
Potsdam, NY 13676-1747

Phone

(315) 265-4065

NPI assigned

Feb 13, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Health Services of Northern New York

  • Home Health Agency
  • Potsdam, NY
  • NPI 1952407033
  NPD (past)

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

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518480000000",
    "number": "1427558782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 MARKET ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 MARKET ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761747",
            "telephone_number": "315-265-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESPAW",
        "first_name": "JACKALYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-13",
        "last_updated": "2018-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "NY",
            "license": "616272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa M Davis
• Pota John Davis
• Brooke Ann Marie Decelles, MS, RD, CDN
• Miranda Lee Deleel, L.P.N.
• Margrethe Frank Demers, MHC
• William J Detorres III, MD
• John C Devine, MD
• Shirley Ann Dickinson
• Brittany N. Disalvo
• Johnathan Mark Domenico, PA-C

• Case Management Registered Nurse in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Case Management Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; 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.