Individual provider Active NPI

Jennelyn Velma Fraser-Johnson, F.N.P

  • Family Nurse Practitioner
  • Brooklyn, NY
National Provider Identifier
1760535355
Registry record updated Mar 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F333179 Issued in NY
Practice address
585 Schenectady Ave
Brooklyn, NY 11203-1822
Phone
(718) 604-5397
Fax
(718) 604-5527
NPI assigned
Jan 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2009

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 F333179 NY Primary

Addresses

Primary practice location

585 Schenectady Ave
Brooklyn, NY 11203-1822

Mailing address

585 Schenectady Ave
Brooklyn, NY 11203-1822
Phone (718) 604-5397

Other identifiers 1

IdentifierTypeStateIssuer
F333179OtherNYNYS NP LICENSE

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
I20141028001077 NY Practitioner - Nurse Practitioner 3870714215 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F333179NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Interfaith Professional Physician Services, P.C. CurrentSince Dec 23, 2025 Accepting new patients
Kingsbrook Medical Associates, PC Current Accepting new patients
Kingsbrook Medical Associates PC CurrentSince Sep 30, 2014 Accepting new patients

Locations

1545 Atlantic Ave
Brooklyn, NY 11213
Phone (718) 613-4175

585 Schenectady Ave
Brooklyn, NY 11203
Phone (718) 604-0461

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

Organizations & group practices 3

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": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238112000000",
    "number": "1760535355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 SCHENECTADY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031822",
            "telephone_number": "718-604-5397",
            "fax_number": "718-604-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 SCHENECTADY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031822",
            "telephone_number": "718-604-5397",
            "fax_number": "718-604-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER-JOHNSON",
        "first_name": "JENNELYN",
        "middle_name": "VELMA",
        "name_prefix": "Ms.",
        "credential": "F.N.P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2009-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F333179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS NP LICENSE",
            "identifier": "F333179",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.