Jennifer Lee Kolettis, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

041-427636 Issued in IL

Practice address

320 E Armstrong Ave
Peoria, IL 61603-3172

Phone

(309) 680-7600

Fax

(309) 495-8614

NPI assigned

Dec 7, 2018

Last updated

Dec 7, 2018By the provider in NPPES

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

Other names 1

• Jennifer Bernstein Former name

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1790256303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 N UNIVERSITY ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616043221",
            "telephone_number": "309-680-7669",
            "fax_number": "309-681-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033172",
            "telephone_number": "309-680-7600",
            "fax_number": "309-495-8614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLETTIS",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-07",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "041-427636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BERNSTEIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Miranda Kocher, M.S. CCC-SLP/L
• Marysue Patricia Koelling
• Michael Koeppen, MD
• Truc-Quynh D Kohlmeyer
• Stephanie Kok, M.D.
• Yannis N Kolettis, M.D.
• Venkat Yashaswi Kondapalli
• Derek Koon
• Kathleen Koors
• Christopher Kopan

• Family Nurse Practitioner in Peoria, IL
• Providers in Peoria, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.