Individual provider Active NPI

Jenny Beatrix Jelliffe, MSN

  • Gerontology Registered Nurse
  • Watertown, MA
National Provider Identifier
1477860401
Registry record updated Sep 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Registered NurseTaxonomy code 163WG0600X
License
198155 Issued in MA
Practice address
200 Dexter Ave
Suite K
Watertown, MA 02472-4238
Phone
(617) 600-3195
Fax
(617) 924-1207
NPI assigned
Sep 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Registered Nurse 163WG0600X 198155 MA Primary

Addresses

Primary practice location

200 Dexter Ave
Suite K
Watertown, MA 02472-4238

Mailing address

200 Dexter Ave
Suite K
Watertown, MA 02472-4238
Phone (617) 600-3195

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)
Not enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
198155MAMDGerontology Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284336000000",
    "number": "1477860401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 DEXTER AVE",
            "address_2": "SUITE K",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724238",
            "telephone_number": "617-600-3195",
            "fax_number": "617-924-1207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DEXTER AVE",
            "address_2": "SUITE K",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724238",
            "telephone_number": "617-600-3195",
            "fax_number": "617-924-1207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELLIFFE",
        "first_name": "JENNY",
        "middle_name": "BEATRIX",
        "name_prefix": "Ms.",
        "credential": "MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-13",
        "last_updated": "2010-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "MA",
            "license": "198155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.