Individual provider Active NPI

Kristan Jorde

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1689301244
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95021540 Issued in CA
Practice address
726 Broadway
New York, NY 10003-9616
Phone
(212) 443-1000
NPI assigned
Aug 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 05021540 CA
Family Nurse Practitioner 363LF0000X 95021540 CA Primary

Addresses

Primary practice location

726 Broadway
New York, NY 10003-9616

Mailing address

726 Broadway
New York, NY 10003-9616
Phone (212) 443-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20221130000169 CA Practitioner - Nurse Practitioner 1254709975 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
05021540CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shasta Community Health Center Family Medicine CurrentSince Nov 1, 2022 Accepting new patients
Shasta Community Health Center CurrentSince Nov 1, 2022 Accepting new patients
Shasta Community Health Center Current Accepting new patients

Locations

1035 Placer St
Redding, CA 96001

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1689301244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100039616",
            "telephone_number": "212-443-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100039616",
            "telephone_number": "212-443-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDE",
        "first_name": "KRISTAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-04",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "05021540",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95021540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.