Jacquelyn Marie Thayer

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

THAY-6BQ212 Issued in NC

Practice address

2006 Bainbridge St Apt 2F
Philadelphia, PA 19146-1373

Phone

(267) 844-5791

NPI assigned

May 30, 2018

Sex

Female

Sole proprietor

Yes

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

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": "1527638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527638400000",
    "number": "1467944199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 BAINBRIDGE ST APT 2F",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461373",
            "telephone_number": "267-844-5791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 BAINBRIDGE ST APT 2F",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461373",
            "telephone_number": "267-844-5791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAYER",
        "first_name": "JACQUELYN",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-30",
        "last_updated": "2018-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NC",
            "license": "203871",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "THAY-6BQ212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael E Thase, MD
• Jaina Marie Thatch, DPT
• Jonathan William Thatcher, BA
• Parinita Thavanati, PA-C
• Andrew Thayer
• Meena Thayu, M.D.
• The 58TH Street Presbyterian Homes
• The Aeroclinic PHL
• The Afritude Institute
• The Afritude Institute,LLC

• Psychiatric/Mental Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 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.