Jessica Anne Wahby, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704334199 Issued in MI

Practice address

22250 Providence Dr Ste 406
Southfield, MI 48075-6212

Phone

(248) 557-9010

NPI assigned

Jul 5, 2023

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

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Michigan Kidney Consultants PCGroup PAC ID 1052207115, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwahby54973@direct.acumenmd.com
• Direct secure messaging: jwahby3175656@direct.trinity-health.org

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.

• Michigan Kidney Consultants, P.C.

  • Nephrology Physician
  • Sterling Heights, MI
  • NPI 1831130723
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1700564325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20058 BANNISTER DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480445942",
            "telephone_number": "586-265-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22250 PROVIDENCE DR STE 406",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480756212",
            "telephone_number": "248-557-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHBY",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704334199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caterina Wagner
• Dejanae Tianna Wagner
• Karl Gordon Wagner Jr., PA-C
• Madison Wagner
• Megan Wagner
• Annette L Wahl, NP
• Sudhir Walavalkar, MD
• Charnice Walden
• Craig Waldie, CRNA
• Walgreen Co

• Family Nurse Practitioner in Southfield, MI
• Providers in Southfield, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.