Individual provider Active NPI

Jennifer Jantzen, ANP

  • Nurse Practitioner
  • Lexington, KY
National Provider Identifier
1497990303
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3005892 Issued in KY
Practice address
1221 S Broadway
Lexington, KY 40504-2701
Phone
(859) 258-4000
NPI assigned
Dec 5, 2008
Last updated
Sep 18, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3005892 KY Primary
Nurse Practitioner 363L00000X 5892P KY

Addresses

Primary practice location

1221 S Broadway
Lexington, KY 40504-2701

Mailing address

1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-6000

Other practice location 1

1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone (502) 636-7225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20090707000173 KY Practitioner - Nurse Practitioner 1456402346 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3005892KYMDNurse Practitioner
5892PKYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Emergency Physicians LLC Nurse Practitioner CurrentSince Sep 1, 2021 Accepting new patients
Southeastern Emergency Services P C Nurse Practitioner CurrentSince Apr 1, 2011 Accepting new patients
Kentuckiana Emergency Physicians, PLLC Past Accepting new patients
Kentuckiana Emergency Physicians Past Accepting new patients

Locations

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

320 N Loretto Rd
Lebanon, KY 40033
Phone (270) 692-3161

150 N Eagle Creek Dr
Lexington, KY 40509
Phone (859) 267-9773

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1497990303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-6000",
            "fax_number": "859-258-6203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 S BROADWAY",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042701",
            "telephone_number": "859-258-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Audubon Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402171318",
            "country_code": "US",
            "telephone_number": "502-636-7225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JANTZEN",
        "first_name": "JENNIFER",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-05",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3005892",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "5892P",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.