Individual provider Active NPI

Colleen Paquette, FNP

  • Family Nurse Practitioner
  • Massena, NY
National Provider Identifier
1700163409
Registry record updated Dec 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F336815-1 Issued in NY
Practice address
1 Hospital Dr
Massena, NY 13662-1056
Phone
(315) 769-4200
NPI assigned
Nov 8, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 602429-1 NY
Family Nurse Practitioner 363LF0000X F336815-1 NY Primary

Addresses

Primary practice location

1 Hospital Dr
Massena, NY 13662-1056

Mailing address

1 Hospital Dr
Massena, NY 13662-1056
Phone (315) 769-4200

Other identifiers 1

IdentifierTypeStateIssuer
03602751MedicaidNY

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140708000505 NY Practitioner - Nurse Practitioner 5597980581 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
602429-1NYMDRegistered Nurse
F336815-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Citizen Advocates, Inc CurrentSince Aug 14, 2022 Accepting new patients
Statline Medical PC CurrentSince Nov 20, 2023 Accepting new patients
Citizen Advocates, Inc CurrentSince Mar 1, 2020 Accepting new patients
Hospice of St Lawrence Valley Inc CurrentSince Dec 23, 2018 Accepting new patients

Locations

15 Francis St
Malone, NY 12953
Phone (518) 483-7801

31 6th St
Malone, NY 12953
Phone (518) 651-2254

451 Broad St
Salamanca, NY 14779
Phone (716) 945-1800

200 White Plains Rd
Ste 110
Tarrytown, NY 10591
Phone (914) 848-4343

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1700163409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621056",
            "telephone_number": "315-769-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621056",
            "telephone_number": "315-769-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAQUETTE",
        "first_name": "COLLEEN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-08",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "602429-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F336815-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03602751",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Massena, NY

Sources for this page

Verify at the official NPI Registry.