Jessicalee P Hollis, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

341842 Issued in NY

Practice address

103 Rensselaer St
Heuvelton, NY 13654-3137

Phone

(315) 344-6621

Fax

(315) 713-6510

NPI assigned

Jul 7, 2017

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

State licenses

Interoperability endpoints

• Direct secure messaging: jhollis@hiemail.healtheconnections.org

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1508388901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 RENSSELAER ST",
            "city": "HEUVELTON",
            "state": "NY",
            "postal_code": "136543137",
            "telephone_number": "315-344-6621",
            "fax_number": "315-713-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 RENSSELAER ST",
            "city": "HEUVELTON",
            "state": "NY",
            "postal_code": "136543137",
            "telephone_number": "315-344-6621",
            "fax_number": "315-713-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIS",
        "first_name": "JESSICALEE",
        "middle_name": "P",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-07",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341842",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "341842",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04889438",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carthage Area Hospital Inc
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• Rene Green, LMT
• Marilynn Jane Harper, LPN
• Heuvelton Central School
• Megan J Johnson, MA, CCC-SLP
• Timothy Michael Kelley Jr., DC
• LMX Paintless Dent Repair LLC
• Lori Ann Montroy, REGISTERED NURSE
• Timothy M Kelley DC PLLC

• Family Nurse Practitioner in Heuvelton, NY
• Providers in Heuvelton, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.