Individual provider Active NPI

Jennifer Lynn Chaffee, RN, MSN-FNP-BC

  • Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1740769660
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
71008091A Issued in IN
Practice address
2121 Lake Ave
Fort Wayne, IN 46805-5100
Phone
(260) 426-5431
NPI assigned
Aug 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 71008091A IN Primary

Addresses

Primary practice location

2121 Lake Ave
Fort Wayne, IN 46805-5100

Mailing address

2121 Lake Ave
Fort Wayne, IN 46805-5100
Phone (260) 409-2007

Other practice location 1

1700 E 38th St
Marion, IN 46953-4568
Phone (260) 426-5431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
71008091AINMDNurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1740769660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-409-2007",
            "fax_number": "260-460-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 LAKE AVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055100",
            "telephone_number": "260-426-5431"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 E 38th St",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "IN",
            "postal_code": "469534568",
            "country_code": "US",
            "telephone_number": "260-426-5431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAFFEE",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "RN, MSN-FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-10",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71008091A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; 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.