Individual provider Active NPI

Jennifer Gathman, MSN, FNP-C, IBCLC

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1659980662
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95025266 Issued in CA
Practice address
16935 W Bernardo Dr Ste 140
San Diego, CA 92127-1664
Phone
(858) 225-4691
NPI assigned
Jul 26, 2020
Last updated
Sep 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Registered Nurse) 163WL0100X 746885 CA
Family Nurse Practitioner 363LF0000X 95025266 CA Primary

Addresses

Primary practice location

16935 W Bernardo Dr Ste 140
San Diego, CA 92127-1664

Mailing address

16935 W Bernardo Dr Ste 140
San Diego, CA 92127-1664
Phone (858) 225-4691

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
746885CAMDLactation Consultant (Registered Nurse)
95025266CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Village Nest Medical Group Family Current Accepting new patients

Locations

16935 W Bernardo Dr
Ste 140
San Diego, CA 92127
Phone (541) 670-6974

Organizations & group practices 1

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": "1595721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1659980662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16935 W BERNARDO DR STE 140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921271664",
            "telephone_number": "858-225-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16935 W BERNARDO DR STE 140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921271664",
            "telephone_number": "858-225-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATHMAN",
        "first_name": "JENNIFER",
        "credential": "MSN, FNP-C, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-26",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "CA",
            "license": "746885",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95025266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.