Jennifer Diane Khan, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

341927 Issued in NY

Practice address

33-57 Harrison St
Johnson City, NY 13790-2107

Phone

(607) 763-6638

NPI assigned

Aug 25, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Diane Lake Former name

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

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• United Medical Associates PC

  • Clinic/Center
  • Binghamton, NY
  • NPI 1013972801
  Medicare reassignment NPD
• United Medical Associates, P.C.

  • Durable Medical Equipment & Medical Supplies
  • Binghamton, NY
  • NPI 1629252556
  NPD

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

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1679090187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 JOHNSON AVE",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054341",
            "telephone_number": "607-206-3147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-57 HARRISON ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902107",
            "telephone_number": "607-763-6638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52 Harrison St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "NY",
            "postal_code": "137902120",
            "country_code": "US",
            "telephone_number": "607-729-8845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "JENNIFER",
        "middle_name": "DIANE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-25",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "341927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "LAKE",
            "middle_name": "DIANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shane Keogh, MD
• Timothy D Keyes, PA
• Muhammad Talha Khalid, MD
• Sabeen Khalid, DO
• Irfan Khan, MD
• Mustafa Ali Khan, DO
• Serazul A Khan, MD
• Hotek Kim, MD
• Kyung In Kim, MD
• Jeffrey M King, M.D.

• Family Nurse Practitioner in Johnson City, NY
• Providers in Johnson City, 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 Aug 7, 2023; 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.