NPIMap

Individual provider Active NPI

Jaclyn Rae Tyson, CRNP

  • Family Nurse Practitioner
  • Easton, PA
National Provider Identifier
1740661693
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP014350 Issued in PA
Practice address
3735 Nazareth Rd Ste 206
Easton, PA 18045-8346
Phone
(484) 503-8281
NPI assigned
Jun 16, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP014350 PA Primary

Addresses

Primary practice location

3735 Nazareth Rd Ste 206
Easton, PA 18045-8346

Mailing address

801 Ostrum St
Bethlehem, PA 18015-1000
Phone (484) 503-8281

Other names 1

  • Jaclyn Rae Bivaletz Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210419002698 PA Practitioner - Nurse Practitioner 7719395441 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gslpg, IncGroup PAC ID 7810226875, 269 clinicians
St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

100 Paramount Blvd
Orwigsburg, PA 17961-2202
Phone (484) 526-2440

3735 Nazareth Rd
Suite 206
Easton, PA 18045-8346
Phone (610) 252-8281

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.13 of 100Reported as apm
Quality
82.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP014350PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gslpg, Inc CurrentSince Sep 4, 2022 Accepting new patients
St. Luke's Physician Group, Inc. Current Accepting new patients
St. Luke's Physician Group, Inc. CurrentSince May 3, 2021 Accepting new patients
St Luke's Physician Group Inc CurrentSince May 3, 2021 Accepting new patients
St. Luke's Physician Group, Inc Past Accepting new patients
Progressive Physician Assoc Inc PastSince Oct 24, 2021 Accepting new patients

Locations

235 E Brown St
#1
East Stroudsburg, PA 18301

3735 Nazareth Rd
Ste 206
Easton, PA 18045

1700 St Lukes Blvd
Ste 301
Easton, PA 18045
Phone (484) 503-0500

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

100 Paramount Blvd
Orwigsburg, PA 17961
Phone (272) 639-1000

Interoperability endpoints

  • Direct secure messaging: jaclyn.tyson@slpg.direct-sluhn.org

Organizations & group practices 6

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762819200000",
    "number": "1740661693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 OSTRUM ST",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180151000",
            "telephone_number": "484-503-8281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3735 NAZARETH RD STE 206",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180458346",
            "telephone_number": "484-503-8281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "JACLYN",
        "middle_name": "RAE",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP014350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "BIVALETZ",
            "middle_name": "RAE",
            "credential": "CRNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Easton, PA

Sources for this page

Verify at the official NPI Registry.