Jean Marie Odoherty, ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

303085 Issued in NY

Practice address

342 Beach 54TH St
Arverne, NY 11692-1782

Phone

(718) 634-5448

NPI assigned

Sep 6, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654041600000",
    "number": "1730374455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 BEACH 54TH ST",
            "city": "ARVERNE",
            "state": "NY",
            "postal_code": "116921782",
            "telephone_number": "718-634-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 BEACH 54TH ST",
            "city": "ARVERNE",
            "state": "NY",
            "postal_code": "116921782",
            "telephone_number": "718-634-5448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 New York Ave",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "NY",
            "postal_code": "115612821",
            "country_code": "US",
            "telephone_number": "516-232-3748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODOHERTY",
        "first_name": "JEAN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-06",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "303085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "odojean812@optonline.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "342 Beach 54th St",
            "city": "Arverne",
            "state": "NY",
            "country_code": "US",
            "postal_code": "116921782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Arverne, NY
• Providers in Arverne, NY by specialty
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.