Jacqulyn Nicole Lopez, MSN, RN, FNP-C

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

28190531A Issued in IN

Practice address

8935 N. Meridian Street
Suite #107
Indianapolis, IN 46260

Phone

(317) 924-2390

Fax

(317) 924-2391

NPI assigned

Jun 15, 2016

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

• Jacqulyn Nicole Burgess Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644883200000",
    "number": "1801246467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8935 N. MERIDIAN STREET",
            "address_2": "SUITE #107",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46260",
            "telephone_number": "317-924-2390",
            "fax_number": "317-924-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8935 N. MERIDIAN STREET",
            "address_2": "SUITE #107",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46260",
            "telephone_number": "317-924-2390",
            "fax_number": "317-924-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "JACQULYN",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "MSN, RN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-15",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28190531A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQULYN",
            "last_name": "BURGESS",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ana Marie Lopez, MD
• Anselma Lopez
• Casie Lopez, LCSW,
• Gabriela Lopez
• Hannah Lopez
• Katherine L Lopez, O.D.
• Kevin Jose Lopez, MD
• Laura Marquez Lopez, PA
• Leah Lopez, RBT
• Perry Lopez, O.D.

• Registered Nurse in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Registered Nurse in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.